PPH术治疗急性嵌顿环状混合痔32例

目的：探讨吻合器痔上黏膜环切术（PPH术）对急性嵌顿环状混合痔的临床应用价值及手术方法。方法：应用痔环切吻合器（强生PPH03）对32例急性嵌顿环状混合痔施行手术治疗。结果：全部治愈，平均手术时间21min,平均住院时间6d。术后尿潴留15例，术后止痛19例，术后无大出血、感染、肛门失禁及肛门狭窄，无肛缘水肿。结论：PPH术治疗急性嵌顿环状混合痔安全有效，手术及住院时间短、恢复快、并发症少等。     

Measurement of blood loss at childbirth and postpartum.

OBJECTIVE: To accurately measure blood loss during childbirth in a developing country. METHOD: The alkaline hematin technique was used to quantify blood lost during delivery and 24 h postpartum in 158 women in Pemba Island, Zanzibar. RESULT: Women were found to lose less blood during childbirth and 24 h postpartum than previously reported. Compared with laboratory values, nurse-midwives approximated blood loss accurately (mean difference, i.e., mean underestimation by nurse-midwives, 4.90 mL); however, their imprecision was greater for higher laboratory values. CONCLUSION: This study may prompt further investigation, as no comparable data exist for developing countries where maternal mortality is high and severe anemia prevalent.     

PPH加黏膜柱状缝合、直肠周围高位注射治疗完全性直肠脱垂(附15例报告)

目的：探讨PPH加黏膜柱状缝合、直肠周围高位注射治疗完全性直肠脱垂的手术效果。方法：对15例完全性直肠脱垂（Ⅰ～Ⅱ度）患者，采用PPH加黏膜柱状缝合、直肠周围高位注射治疗。结果：治愈15例，无复发。结论：该术式操作简单，近期疗效好，远期效果有待进一步观察。     

痔上粘膜环切术的临床应用

目的探讨吻合器痔上粘膜环切术㈣治疗环状重度内痔的疗效。方法用PPH治疗环状重度内痔患者23例。结果23例手术时间（含消毒铺巾）为30～60min，4例因荷包缝扎过低而导致疼痛需使用镇痛剂外，其余均无明显痛感。术后脱垂痔核立即消失的18例，92％的患者术后3个月内痔核可以完全消失。术后仅1例有明显便血症状，经药物治疗后症状消失。无术后感染、出血、狭窄、瘘管形成及肛门失禁等并发症发生，患者对此手术的总体满意率达92％。结论PPH治疗环状重度内痔具有安全、有效、手术时间和住院时间短、恢复快等优点。     

The impact of post-partum haemorrhage in “near-miss” morbidity and mortality in developing countries

The global maternal mortality ratio (MMR) of 400 per 100,000 live births results in an estimated 529,000 maternal deaths annually. Most of these deaths occur in developing countries and only about 1% in developed countries. Besides mortality data, the identification and accurate documentation of “near-miss” morbidity (a more sensitive index) is extremely important to assess the quality of health care systems. It can suitably guide to adopt appropriate measures to reduce maternal mortality and morbidity. Haemorrhage remains a major cause of maternal mortality in both developing and developed countries followed by anaemia and infection, which are more common in developing countries. Post-partum haemorrhage (PPH) is a frequent complication of delivery. PPH occurred in 10.5% of all live births worldwide resulting in 13,795,000 cases in the year 2000. The case fatality rate for PPH was 1% and there were 132,000 deaths attributable to PPH. Anaemia as a consequence of PPH was estimated to occur in 1.6 million women every year. Thus, the prevention and adequate management of obstetric haemorrhage are likely to result in a significant reduction in the MMR and in the less frequently monitored “near-miss” morbidity. Strategies to be adopted with regard to PPH in developing countries may differ from those routinely available and practised in developed countries because of limited access to health care facilities and low institutional delivery rate in the former countries. Some low cost, simple techniques to prevent and manage PPH are described. These need to be tested in a wider population to determine which is most suitable for a particular area or country. The mortality and “near-miss” morbidity data should be continually assessed and only then will the impact of these strategies be known. First level midwifery care plus backup by well-equipped hospitals must be developed concomitantly. Anyone can conduct a normal delivery when all is going well but only those with good clinical judgement and the necessary skills will be able to anticipate and manage a problem. This is especially important in the context of PPH where the under-estimation of blood loss coupled with the rapidity of development of serious consequences is the key issue.     

Milligan-Morgan术式联合痔核套扎术治疗痔病的经验

目的介绍Milligan-Morgan术(M-M术)联合痔疮套扎术(M-M-R术)治疗痔病的经验和优势。方法选择2014年7月~2015年12月Ⅲ期~Ⅳ期痔病接受(M-M-R组)术治疗的患者91作为观察对象,另选择具有可比性的同期接受吻合器痔上黏膜环切术(PPH)78例作为对照(PPH组),观察各组患者的术中情况、术后表现,并发症发生、住院费用、术后住院时间以及满意度等方面情况。结果 M-M-R和PPH术式的手术用时为(42.7±28.6)min和(28.5±5.3)min,两组相比较有统计学意义。两组手术出血量均小于10 m L。M-M-R组与PPH组在术后疼痛(VAS)、肛门坠涨感、肛缘水肿方面差异具有统计学意义,但上述表现均短期内恢复。M-M-R组最明显优势是费用明显少于PPH组(P0.05)。两组手术的满意度差异没有统计学意义。术后便血、排尿、术后住院时间以及满意度,直肠-肛管反射功能两组比较差异无统计学意义。随访3月,两组均为发生肛门狭窄、大便再出血、复发等情况。结论 M-M-R术式效果至少在短期内与PPH相当,术后肛门疼痛患者可以接受;由于治疗费用相对低廉,M-M-R术尤其适合于基层医院实施。     

PPH吻合器治疗严重脱垂性内痔的疗效对比

目的：探讨PPH吻合器治疗严重脱垂性内痔的疗效。方法严重脱垂性内痔患者90例根据治疗方法的不同分为治疗组与对照组各45例，治疗组采用PPH吻合器治疗，对照组采用外剥内扎法治疗。结果两组手术经过均顺利，无麻醉意外，都痊愈出院。不过治疗组的手术时间、术后住院时间与术中缝扎止血例数明显少于对照组，差异有统计学意义（P＜0.05）。治疗组术后疼痛、水肿与尿潴留的发生率明显少于对照组，差异有统计学意义（P＜0.05）。结论PPH吻合器治疗严重脱垂性内痔创伤少，患者恢复快，术后安全性好，是一种微创、安全、有效的手术方法。     

PPH治疗出血性内痔128例临床观察

为探讨吻合器痔上黏膜环切术（PPH）治疗出皿性内痔的町行性，对128例出血性内痔行PPH。结果显示，128例患者手术顺利，手术时间30～45min，平均35min．住院时间4～7d．术后48h无疼痛，术后未见肛门有明显的出血；5例术后出现直肠刺激症状，肛门见异常。结果表明，PPH治疗出血性内痔疗效确切．并发症少，恢复快，值得临床推广。     

“局麻-PPH-门诊留观三日”模式治疗重度环状痔578例临床分析

为探讨“局麻-PPH-门诊留观三日”模式治疗重度环状痔的疗效及可行性，回顾分析578例局麻下行PPH治疗的患者资料。结果显示，本组全部治愈，平均手术时间25rain，平均门诊留观时间2．9d，局麻时感疼痛难忍者189例，术后发生尿潴留35例，术后近期发生创口活动性出血而再次进手术室止血3例，术后发生肛门创缘水肿38例，术后发生急性便秘20例，但无一例发生肛门失禁、肛门狭窄及肛周化脓性感染。结果表明，“局麻-PPH-门诊留观三日”模式治疗重度环状痔安全、有效、可行。     

Risk factors for early postpartum hemorrhage (PPH) in the first vaginal delivery,and obstetrical outcomes in subsequent pregnancy

Objective: To investigate risk factors for postpartum hemorrhage (PPH) in vaginal deliveries and the influence of previous PPH on the subsequent pregnancy.

Study design: A retrospective cohort study including first singleton deliveries between the years 1988 and 2012 was performed comparing deliveries with and without PPH. In addition, perinatal outcomes of the subsequent pregnancy were evaluated. Multivariable analysis was performed to control for confounders.

Results: PPH complicated 0.8% of all first vaginal deliveries. Significant risk factors for PPH in vaginal delivery, using a multiple logistic regression model, were: post-term pregnancy, fertility treatments, hypertensive disorders, labor dystocia during the 2nd, and perineal tears grade 2 and 3, respectively. Previous PPH was found to be an independent risk factor for PPH in the subsequent pregnancy. Moreover, previous PPH was found to be a significant risk factor for cesarean section (CS) deliver, to complicate delivery with revision of uterus cavity, anemia, and to require blood transfusion.

Conclusion: Previous PPH poses a risk for recurrent PPH in subsequent delivery and an increased risk for CS. As PPH remains one of the major causes of maternal morbidity, this study strengthens the need for a comprehensive evaluation of prior PPH as a major risk factor for PPH recurrence.