吻合器痔上粘膜环切术治疗严重脱垂性内痔

目的：探讨吻合器痔上粘膜环切术(PPH)治疗严重脱垂性内痔的临床应用价值。方法：经PPH手术治疗严重脱垂性内痔32例。结果：平均手术时间13．5min，术毕时脱出痔团大部分回缩入肛管内，2d内完全回缩入肛26例，余在术后7～10d内完全回缩。术中轻微下腹痛5例，吻合口均有不同程度出血或渗血，予缝扎或用0．01‰肾上腺素液纱布压迫后均止血。术后尿潴留7例，肛门轻微疼痛4例，中度疼痛2例，无一例出血，住院1～3d。随访1—20个月，无肛门狭窄、大便失禁、肛门外翻、肛门异物感和排便障碍等并发症，无复发。结论：PPH治疗严重脱垂性内痔具有安全、有效、住院时间短、恢复快的优点，有望成为治疗严重脱垂性内痔的首选方法，其远期疗效有待进一步观察。

Stapled Procedure for Prolapse and Hemorrhoids (PPH) for Severe Prolapsed Internal Hemorrhoids

Objective To explore the value of the procedure for prolapse and hemorrhoids (PPH) for severe prolapsed internal hemorrhoids. Methods 32 cases with severe prolapsed internal hemorrhoids underwent PPH. Results The average operation time was 13.5 minutes. In the 32 cases, most of the prolapsed hemorrhoids drew back into the anus tube at the end of operation,26 completely drew back within 2 days, and the others was in 7 to 10 days after operation. Five patients had mild pain in lower abdomen during operation. 7 had urinary retention, 4 had mild and 2 had moderate anal pain after operation. No hemorrhage occured. The hospital stay was 1 to 3 days. All patients were follewed up for 1 to 20 months, no complications of PPH such as anal stricture and fecal incontinence occurred. No case relapsed. Conclusions PPH is a safe and effective method with short operation time and fast recovery for severe prolapsed internal hemorrhoids. PPH is expected to be the primary choice for severe prolapsed internal hemorrhoids, but long term outcome needs further observation.