痔上黏膜环切钉合术中常规缝扎痔动脉搏动对术后出血的影响

目的:探讨痔上黏膜环切钉合术(PPH)术中常规缝扎痔动脉对预防术后出血的效果.方法:采用信封法将200例无痔手术史的Ⅲ、Ⅳ度内痔患者随机分成PPH术中常规缝扎痔动脉组(A组,96例)和单纯行PPH手术组(B组,104例).比较2组患者的手术情况和术后并发症发生情况.结果:2组患者手术时间、术中触及痔动脉搏动数量和住院时间差异均无统计学意义(P>0.05);A组肛门术后最大疼痛强度评分明显高于B组(P<0.01),A组中78例(81.13%)患者术后有明显的肛门坠胀感.2组患者术后严重出血、恶心呕吐、尿潴留、肛周脓肿、肛门镜检查、排便困难和吻合口狭窄等并发症发生情况差异均无统计学意义(P>0.05).结论:PPH术中常规缝扎痔动脉搏动部位并不能有效防止术后出血,且增加患者肛门坠胀疼痛,痔动脉缝扎只考虑在某些特定情况下使用.

Effect of the conventional suturing hemorrhoid artery during the PPH on the preventing of the post-operative hemorrhage

Objective:To evaluate the effects of the conventional suturing hemorrhoid artery during the procedure for prolapse and hemorrhoids( PPH) on preventing post-operative hemorrhage. Methods:Two hundred Ⅲ and Ⅳ degree hemorrhoids patients without the history of hemorrhoid surgery were randomly divided into the conventional suturing hemorrhoid artery during the PPH group( group A,96 cases) and single PPH group(group B,104 cases). The operation and postoperative complications between two groups were compared. Results:The differences of the surgery duration(minute),number of haemorrhoids artery pulse and length of stay(day) between two groups were not statistically significant(P>0. 05). The score of the postoperative maximum pain intensity in group A was significantly higher than that in group B(P <0. 01). The significant anal bulge feeling in 78 cases of group A(81. 13%) were observed. The differences of the severe anal bleeding,postoperative nausea or vomiting,urinary retention,perianal swelling,rectoscopy, constipation and anastomotic stenosis between two groups were not statistically significant(P>0. 05). Conclusions:The conventional suturing hemorrhoid artery during the PPH can not effectively prevent the post-operative hemorrhage, and increase the anal swelling pain. The suturing hemorrhoidal artery can be used in some specific conditions.