PPH术式大出血原因及防治

目的探讨痔上黏膜环形切除术（PPH）大出血的原因及相应预防。方法选择本院接受PPH术式的术后大出血患者46例进行分析,总结PPH术后大出血的原因及防治措施。结果本组753例中46例发生大出血,其中术后24 h以内的32例,大于24 h的14例,其中有2例为术后超过15天;镜检发现吻合口广泛渗血的有11例,予0.1%肾上腺素5~6 mL注入到直肠内,同时予纱布包裹排气管置于吻合口,观察一段时间可视出血情况可予重复使用;搏动性出血的有35例,均予可吸收肠线做8字缝合止血。所有术后出血患者经处理均未再发生出血。结论手术者经验、肛管直肠吻合器的质量及有效使用次数、术后大便的干燥、感染等因素均是该术式大出血的原因,临床上应根据不同的原因提前干预做好预防工作,对于已大出血者应采用多种止血方法,以达到准确、快速止血的目的 。

Causes and Prevention of Surgical Bleeding About the Operation of PPH

Objective To know the causes of bleeding and corresponding preventive means about PPH.Methods 46 patients received PPH with bleeding in our hospital were analyzed and the causes and preventive measures were summarized.Results 753 cases received PPH,and bleeding occurred in 46 cases,of which 32 cases had bleeding in less than 24 hours after surgery,14 cases had bleeding longer than 24 hours.Microscopic examination found extensive anastomotic bleeding in 11 patients,and pulsatile bleeding in 35 cases.The measures to stop bleeding including 5~6 ml of 0.1% for adrenaline injected into the rectum and to suture directly.Conclusion Surgeon experience,the quality of anorectal stapling and effective use of frequency,dry stool after surgery,infection and other factors are the reasons for the surgical bleeding.Clinical means should be based on early intervention in the different preventive measures,to achieve the purposes of accurate and rapid hemostasis.