吻合器黏膜环切术治疗重度痔的临床观察

目的：探讨吻合器黏膜环切术(PPH)与传统手术方法治疗重度痔的疗效差异。方法：分别采用PPH手术(PPH组)和痔环切除术(对照组)治疗重度痔(Ⅲ、Ⅳ期)各23例。观察比较两组的麻醉、手术时间，术后早期并发症、住院时间、恢复工作时间等。结果：PPH组手术时间短，出血量少，操作简单，早期并发症少，平均住院时间短，恢复工作时间快。结论：PPH作为治疗重度痔疮的新方法，因其手术安全、手术时间短，并发症少、恢复快，疗效确切，值得进一步推广应用。     

PPH与传统手术治疗重度痔的疗效比较

目的比较PPH与传统手术（Milligan-Morgan）治疗重度痔的疗效。方法42例重度痔患者随机分为实验组（PPH,22例）和对照组（Milligan-Morgan术,20例）,对两组的手术时间、住院时间、恢复正常时间、治疗有效率、并发症和随访结果等进行统计学分析。结果PPH组手术时间13.3±2.5min,平均住院4.0±1.2 d,恢复正常时间7.8±4.6 d,并发症发生率低,均较对照组（平均手术时间44.5±12.7min,平均住院6.4±3.2d,并发症发生率高）为好,PPH组有效率95.5%,高于传统手术组的80.0%;随访随访1年,两组复发率及需要进一步治疗的患者等比较实验组优于对照组,两组差异有统计学意义（〈0.05）。结论PPH手术比传统手术治疗重度痔疮方法便捷、安全、有效。     

PPH治疗急性嵌顿痔(附56例报告)

目的：探讨吻合器痔上黏膜环切术(PPH)的临床应用价值。方法：利用特制的圆形痔吻合器对56例急性嵌顿痔进行手术治疗。结果：手术时间平均10min，住院时间平均4d，97％的病人对手术效果满意。术后常见的并发症：尿潴留18例(32．1％)，术后当日无肛门疼痛39例(69．6％)，肛门部疼痛17例(30．4％)，术后5～9d便血3例(5．4％)，1例缝扎止血治愈，2例经保守治疗后好转。下腹不适及胀痛14例(25％)，大便次数增多8例(14．3％)。随访2周至20个月，无复发、肛门狭窄、大便失禁发生。结论：PPH治疗嵌顿痔是一种革新技术，与传统手术比较，具有安全、有效、术后痛苦少、住院时间短、损伤小、恢复快、复发率低、并发症少等优点，有望替代传统手术疗法，但远期疗效有待于进一步论证。     

120例重度痔病PPH手术疗效分析

目的 探讨PPH的手术技巧和应用价值。方法 将120例重度痔患者分为双荷包PPH组和单荷包PPH组，每组均为60例。比较观察两组的手术时间、术后疼痛、术后并发症及术后复发情况。结果 双荷包PPH组与单荷包PPH组比较，手术时间、术后疼痛无显著差异（P〉0．05），但双荷包PPH组术后并发症发生率、复发率低（P〈0，01）。结论 在治疗重度痔病中，双荷包PPH术明显优于单荷包PPH术，术后并发症少，复发率低。     

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。     

PPH合并手术的临床疗效评价

目的：评价PPH合并手术治疗痔病的临床疗效。方法：PPFI合并手术治疗49例Ⅱ～Ⅳ度痔，其中部分合并肛乳头肥大、肛裂、低位单纯性肛瘘，与同期单纯PPH手术47例作比较研究。结果：两组在手术时间、术后疼痛指数、术后并发症、住院时间、住院费用、恢复工作时间方面没有显著性统计学差异。结论：PPH合并手术可以弥补单纯：PPH手术的局限性，不但可以拓展其治疗范围，同时还可以获得更好的远期疗效。     

PPH结合痔切除与Milligan-Morgan手术治疗重度痔的对比研究

目的:比较PPH结合痔切除手术与传统Milligan-Morgan手术治疗重度混合痔的临床效果.方法:对收治的100例重度混合痔分为实验组和对照组,分别进行PPH结合痔切除手术及Milligan-Morgan手术治疗.并分别对手术时间、术后疼痛指数、注射止痛剂次数、住院时间、恢复工作时间、术后并发症、患者满意度等进行比较分析.结果:在患者症状改善满意度、术后并发症及恢复工作时间方面,PPH结合痔切除手术明显优于对照组(P＜0.01);而在手术时间、术后疼痛指数、注射止痛剂次数方面实验组亦优于对照组(P＜0.05);住院时间上两者差异不显著.结论:对合并有明显外痔的重度混合痔仍可采用PPH手术,其疗效优于传统的外剥内扎术.     

吻合器痔上黏膜环切术治疗急性嵌顿环状混合痔16例

目的掌握应用吻合器痔上黏膜环切术（PPH）的适应证。方法回顾性分析16例急性嵌顿痔PPH术治疗患者的临床资料,对患者的手术时间、住院时间、术后并发症等进行分析。结果手术时间平均8min,术后住院时间平均3．5d,PPH术在术后并发症及住院时间方面有明显优势,98％的患者对手术效果满意。结论PPH术治疗急性嵌顿痔安全、有效。     

PPH与传统痔切除术的比较

目的:探讨PPH治疗痔的疗效.方法:对28例PPH与32例脱垂痔用传统痔切除术(对照组)的结果进行分析比较.结果:手术时间、术后各种并发症的发生、住院时间、恢复工作时间及复发等情况,PPH组占有明显的优势.结论:PPH具有操作简单方便、安全可靠、并发症少、恢复快等优点,是一种治疗重度痔的好方法,有望替代传统手术.     

PPH治疗环状混合痔65例临床观察

为探讨吻合器痔上黏膜环切术（PPH）治疗环状混合痔的临床应用价值及并发症的防治,我们对65例环状混合痔行PPH,并观察患者的平均手术时间、平均住院天数及并发症。结果显示,平均手术时间为21min,平均住院天数4d。术后并发症：尿潴留21例（32．3％）;术中吻合口渗血5例（7．7％）,术后5～7d排便用力后突然大量便血再次入院2例（3．1％）;术后当天下腹疼痛2例（3．10）;肛门疼痛7例（10．8％）。随访1～6个月无复发,无大便失禁、肛管狭窄等严重并发症。结果表明,PPH治疗环状混合痔与传统手术比较,具有安全、有效,术后痛苦少、恢复快,住院时间短。复发率低,并发症少等优点。     

Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial

Objective: The use of a circular stapler in cervical esophagogastric anastomosis remains controversial. This study was to compare the postoperative and long-term results of manual and mechanical techniques for cervical esophagogastric anastomosis after resection for squamous cell carcinoma. Methods: A prospective randomized controlled trial was undertaken in 63 patients with curatively resectable squamous cell cancer of the thoracic esophagus between 1996 and 1999. Patients were randomized to receive either a hand-sewn (32 patients) or circular stapled (31 patients) cervical esophagogastric anastomosis. Results: The mean operating time was longer when the hand-sewn method was used (524 vs. 447 min, P<0.001). Anastomotic leakage was noted in seven patients (22%) in the hand-sewn group and eight patients (26%) in the stapler group (P=NS). Hospital mortality occurred in four patients (13%) of the hand-sewn group and in three patients (10%) of the stapler group (P=NS). After the operation, four patients (14%) in the hand-sewn group and five patients (18%) in the stapler group developed a benign esophageal stricture (P=NS). The mean follow-up time was 24 months, and the rates of freedom from benign stricture and survival were comparable in each group. Conclusions: Performing cervical esophagogastric anastomoses using a circular mechanical stapler had a shorter operating time and a comparable outcome to the hand-sewn method. The circular mechanical stapler could be used as an alternative for cervical esophagogastric anastomosis after resection for esophageal squamous cell cancer.     

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目的 评估吻合器环形痔切除术治疗脱垂性内痔的安全性和实用性。方法 利用特制的环形吻合器对52例Ⅲ、Ⅳ度环形脱垂性内痔进行手术治疗,其中男性24例,女性28例,平均62岁。结果 手术时间平均8min,术后住院时间平均3.5天,98%的病人对手术效果满意。吻合口距齿线距离愈近术后痔块回缩愈明显,但术中吻合口出血的情况愈多,术后肛门部不适的主诉愈多。术后常见的并发症;尿潴留34例（65.4%）,肛门部疼痛42例（80.7%）,大便带血20例（38.5%）,下腹不适及胀痛12例（23.1%）,术后1周左右有排便困难8例（15.4%）,大便次数增多4例（7.7%）,肛门部水肿4例。随访2周至10个月,1例术后4个月复发,无肛门狭窄、大便失禁发生。结论 与传统手术相比吻合器环形痔切除术治疗脱垂性内痔具有手术简单、术后痛苦少、恢复正常生活早、复发率低、并发症少的特点,但远期效果尚待进一步观察。     

A new technique for intestinal isoperistaltic anastomosis utilizing a linear stapler for enlargement after anastomosis performed with a circular stapler

Background The high incidence of anastomotic stenosis after gastrointestinal surgery using circular staplers is a major problem. In response, we have developed a new technique that uses a linear stapler to enlarge an anastomotic opening made using a circular stapler. Methods Anastomoses were created by the new technique or by the conventional approach using a circular stapler in pig small intestine. The method was also applied in treatment of a colon cancer patient. Results The area of the anastomotic opening obtained with the new technique was more than 3 times that in the control (p < 0.001), with no significant difference between the methods in a leak test. Follow-up of the patient undergoing surgery with this approach revealed an uneventful course with a widely patent anastomosis confirmed after 3 months. Conclusions This procedure provides a larger anastomotic opening than conventional anastomosis with circular staplers, without impairing the integrity of the anastomosis.     

Surgical treatment of hemorrhoidal disease using circular mechanical stapler. Analysis of costs

BACKGROUND: An analysis of surgical treatment costs of haemorrhoid disease with the use of a new circular stapler, is made comparing this operation with Milligan Morgan's technique. The money and management saving due to the reduction of operation time and postoperative stay compensates present costs due to stapler. METHODS: 35 uniform patients (number, age, sex, grade of haemorrhoid disease and surgical equipe) are considered and divided into two groups of study to evaluate perspectively the surgical costs. RESULTS: The cost of treatment with stapler per patient is like Milligan Morgan's treatment (1.714.681 lire versus 1.681.893), with an important management saving of postoperative days (16 hours versus 42 hours). CONCLUSIONS: Moreover there are psychologic and social advantages, not quantifiable but considerable, due to the early physical recovery and to the absence of out-patient dressing cycles peculiar of this surgical technique, with a rapid social and working reinstatement of patients (4-5 days versus 4-5 weeks of conventional intervention).     

Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™) after laparoscopic total gastrectomy

Background

Laparoscopic total gastrectomy (LTG) has not become as popular as laparoscopic distal gastrectomy (LDG) because of the more difficult reconstruction technique. Despite various modifications of reconstruction methods after LTG, an optimal procedure has yet to be established. The authors report the newly developed reconstruction technique after LTG: intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil?; Covidien, Mansfield, MA, USA).

Methods

After full mobilization of the abdominal esophagus, the esophagus is transected with an endoscopic linear stapler. The anvil is then transorally inserted into the esophagus by using the OrVil? system. After jejunojejunostomy is performed through a 4-cm midline minilaparotomy, preparing a 50-cm Roux-en-Y jejunal limb, a circular stapler is inserted into the jejunum and introduced into the abdominal cavity. Pneumoperitoneum is established by sealing off the laparotomy wound retractor with a surgical glove attached to the circular stapler. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an endoscopic linear stapler.

Results

Of the 16 patients who underwent this operation, there was no intraoperative complication or conversion to open surgery, and no patient required an extension of the initial incision for anastomosis. Mean operation time and blood loss were 194 min and 272 ml, respectively. One patient developed an intra-abdominal abscess postoperatively. Postoperative fluorography revealed no anastomosis leakage or stenosis in any of the patients. Patients resumed an oral liquid diet on postoperative day 3–5, and the mean postoperative hospital stay was 11 days.

Conclusions

We have successfully performed LTG with Roux-en-Y reconstruction using our technique in 16 patients without any anastomosis complications. We believe that our procedure is a secure and reliable reconstruction method after LTG, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis often is difficult.     

Morbidity after stapled haemorrhoidectomy: long-term results about 140 patients and review of the literature

AIM: The aim of this study was to determine the results and the complications of the treatment of hemorrhoids with circular stapler with a follow-up of 18 months, and to review the complications in the literature. METHODS: From April 1998 to August 1999, 140 patients (83 males and 57 females) with an average age of 43.8 years (range: 19-83 years) underwent haemorrhoidectomy using a circular stapler in three university hospital centers. The degree of hemorrhoids has been classified: three cases of degree II, 97 cases of degree III, and 40 cases of degree IV. All the patients were prospectively evaluated at two weeks, two and 18 months after surgery. RESULTS: The average length of the operation was 18 minutes (range: 8-60 minutes). Mean hospital stay was 36 hours (range: 8-72 hours). There was no intraoperative complication. There was no mortality. The postoperative complication rate was 7.8% (N = 11): there were five cases of bleeding that two complicated by a submucosal hematoma (one was infected and needed a rectotomy on day 21), two cases of urinary retention, and two cases of external hemorrhoid thrombosis. The bleeding occurred in the 12 hours after surgery except for one patient with antivitamin K whith presented a secondary bleeding on day 16. At 18 months, five patients presented a moderate asymptomatic stricture dilated on digital examination. Two patients complained of persistent skin tags. Neither functional trouble nor incontinence to gas, liquids, or solids was presented. With a mean follow-up of 40 months, 90% (N = 112) of the patients were fully satisfied. CONCLUSIONS: Treatment of hemorrhoids with circular stapler appears to be effective with 96% of patients fully satisfied at 18 months. The morbidity rate was low, and no higher than the diathermy excision hemorrhoidectomy. The results are directly dependent on the practice that required a learning, and not on the technique itself.     

吻合器直肠黏膜环状切除加经会阴补片修补术治疗中-重度直肠前突15例报告

目的探讨治疗中-重度直肠前突的手术方式。方法回顾性分析我院自2004年10月~2006年2月应用吻合器直肠黏膜环状切除+经会阴置入补片修补的方法治疗中-重度直肠前突15例的临床资料。结果本组15例全部治愈。术后症状消失,排便通畅。平均手术时间为42min,术后平均住院时间为4.8d。无一例出现严重并发症。结论使用吻合器直肠黏膜环状切除+经会阴置入补片修补的方法治疗中-重度直肠前突操作方便,手术简单,手术时间及住院时间短,疗效好,并发症少,具有临床应用及推广价值。     

New Device for the Introduction of a Circular Stapler in Laparoscopic Gastric Bypass Surgery

Background: In laparoscopic Roux-en-Y gastric bypass (LRYGBP) surgery, the anastomosis between the gastric pouch and the jejunum can be performed using a circular stapler, as described in the original publication by Wittgrove in 1994. The introduction of the circular stapler through the thick abdominal wall in morbidly obese patients can be challenging. To overcome the difficulties of this task, a new device was developed and its use is presented. Method: The new device has the shape of a trocar tip which can be mounted on the circular stapler, giving it the properties of a trocar. Therefore, easier introduction into the abdominal cavity is feasible. The use of the device was assessed analyzing the data of a prospective database, comparing patient groups operated without the device (n=301) and patients operated with the device (n=100). Results: The groups were comparable in age, sex, BMI and number of previous abdominal operations. The wound infection rate at the site of stapler introduction decreased from 6.6% to 1% (P=0.035). The overall operating time, hospital stay and complication rate were unchanged. Conclusion: The new device proved to be useful in daily practice and enabled an easier stapler introduction with fewer wound infections.     

Keyhole procedure: a new technique for intestinal anastomosis with a large opening and less tissue trauma,using both circular and linear staplers

BACKGROUND: We designed a new technique, termed the keyhole procedure, that uses a linear stapler to enlarge the anastomotic opening made with a circular stapler. The present study was performed to evaluate this technique in terms of maximum bursting pressure and area of anastomotic opening and compare it with conventional anastomosis using a circular stapler in an animal model. METHODS: Anastomoses were created by the new technique or by the conventional method in swine small intestine. Anastomosis integrity was assessed by the air leakage test. Anastomotic openings were photographed and measured with an image analyzer. RESULTS: It was found that the area of the anastomotic opening obtained with the new technique was more than 3 times that of the control (P <.001). There was no significant difference between the methods in maximum bursting pressure. CONCLUSIONS: The keyhole procedure provides a larger anastomotic opening than conventional anastomosis with a circular stapler, without impairing the integrity of anastomosis.     

Intracorporeal laparoscopic cecorectal anastomosis

We recently described a laparoscopically assisted subtotal colectomy with extracorporeal antiperistaltic cecorectal anastomosis (CRA). We modified this technique by performing an intracorporeal CRA: the anvil head assembly removed from the circular stapler with an ancillary trocar placed into the anvil shaft is pushed through the bottom of the cecum, the cecum with the anvil head assembly is brought into the pelvis, the circular stapler is inserted into the rectum and the cecoproctostomy is performed. Two patients underwent this new laparoscopic subtotal colectomy with CRA. The operating times were 230 and 260 minutes, respectively. There was no postoperative morbidity. Our results allow us to state that intracorporeally performed antiperistaltic cecoproctostomy after laparoscopic subtotal colectomy is feasible.