吻合器痔上黏膜钉合术后直肠狭窄

目的探讨吻合器痔上黏膜钉合术(PPH)后直肠狭窄的发生情况及处理方法。方法回顾性分析2000年7月至2004年12月共554例行PPH术患者的临床资料和术后随访资料。结果共随访了489例患者,随访率88．3％(489／554),平均随访时间(324±18)d。共12例(12／489, 2．5％)患者在术后89-134(125±5)d出现了直肠狭窄,均可通过肠镜下气囊扩张或切开狭窄环而治愈。术后直肠狭窄的患者术前接受硬化剂治疗(58．3％vs．20．0％,P=0．02)和术后严重疼痛(25．0％vs．6．7％,P=0．003)的比率明显高于术后无直肠狭窄的患者。而两者性别(P=0．32)、既往痔手术史(P=0．11)、手术标本中有鳞形细胞(P=0．77)和术后复发率(P=0．53)的差异无统计学意义。结论PPH术前有硬化剂注射史和术后严重疼痛的患者较易发生术后直肠狭窄,多在术后4个月内发生。

Rectal stenosis following procedure for prolapse and hemorrhoids

OBJECTIVE: To evaluate stenosis of the lower rectum following PPH with special respect to potential predictive factors or stenotic events. METHODS: A retrospective analysis of 554 consecutive patients, which underwent PPH from July 2000 to December 2004 was performed. RESULTS: Only patients with follow-up check were evaluated, thus the analysis includes 489 patients (489/554, 88.3%) with a mean follow-up of (324 +/- 18) days. Rectal stenosis was observed in 12 patients (12/489, 2.5%), the median time to stenosis was 89 - 134 (125 +/- 5) days. All the patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that patients with stenosis had significantly more often prior sclerosis therapy for hemorrhoids (58.3% vs. 20.0%, P = 0.02) and severe postoperative pain (25.0% vs. 6.7%, P = 0.003). Other factors, such as gender (P = 0.32), prior surgery for hemorrhoids (P = 0.11), histological evidence of squamous skin (P = 0.77) or revision (P = 0.53) showed no significance. CONCLUSION: Rectal stenosis is an uncommon event after PPH. Early stenosis will occur within the first four months after surgery. The majority of the stenosis can be cured through colonoscopy surgery. The predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.