肛肠疾病手术前后肛管直肠压力测定的应用

目的:探讨肛肠疾病手术前后肛管直肠压力测定的应用。方法:将2018年5月-2019年5月在上海市松江区方塔中医医院及上海中医药大学附属曙光医院肛肠科行手术治疗的826例肛肠疾病患者作为研究对象,其中,选择性痔上黏膜吻合术246例、单纯外剥内扎术115例、外剥内扎结合内痔套扎术(Automatic Ligation of Hemorrhoids,RPH)153例、低位肛瘘切除术177例、高位肛瘘切开挂线术135例,分别于术前及术后1个月测定肛管直肠压力。结果:选择性痔上黏膜吻合术后直肠静息压、肛管静息压明显低于术前,肛管舒张压高于术前(P<0.05),但肛管最大收缩压与术前相比无明显差异(P>0.05);单纯外剥内扎术术后直肠静息压、肛管静息压明显低于术前,肛管舒张压、肛管最大收缩压明显高于术前(P<0.05);外剥内扎结合内痔套扎术术后直肠静息压、肛管静息压明显低于术前,肛管舒张压、肛管最大收缩压明显高于术前(P<0.05);低位肛瘘切除术术后直肠静息压、肛管静息压、肛管舒张压均高于术前(P<0.05),而肛管最大收缩压与术前相比无明显差异(P>0.05);高位肛瘘切开挂线术术后直肠静息压高于术前,肛管静息压、肛管舒张压低于术前(P<0.05),而与肛管最大收缩压术前相比无明显差异(P>0.05)。结论:肛肠疾病手术前后肛管直肠压力测定的应用效果显著,能准确判断手术效果及患者恢复情况,为医师的进一步诊治奠定了良好基础。

Application of anorectal pressure measurement before and after anorectal surgery

Objective:To investigate the application of anorectal pressure measurement before and after anorectal surgery.Methods:826 patients with anorectal diseases who received surgical treatment in the anorectal department of our hospital from May 2018 to May 2019 were studied.Among them,there were 246 cases of selective hemorrhoid anastomosis,115 cases of simple external stripping and internal ligation,153 cases of external stripping and internal hemorrhoid ligation combined with internal hemorrhoid ligation(namely RPH),177 cases of low anal fistula resection,135 cases of high anal fistula incision and hanging.Anorectal pressure was measured before and one month after surgery,respectively.Results:After selective superior hemorrhoid anastomosis,the rectal resting pressure and anal resting pressure were significantly lower than that before surgery,and the anal diastolic pressure was higher than that before surgery(P<0.05),but the maximum anal systolic pressure was not significantly different from that before surgery(P>0.05).Rectal resting pressure and anal resting pressure after simple external stripping and internal ligation were significantly lower than that before surgery,and anal diastolic pressure and anal maximum systolic pressure were significantly higher than that before surgery(P<0.05).After external stripping and internal hemorrhoid ligation,the rectal resting pressure and anal resting pressure were significantly lower than the preoperative level,and the anal diastolic pressure and anal maximum systolic pressure were significantly higher than the preoperative level(P<0.05).The rectal resting pressure,anal resting pressure and anal diastolic pressure after low anal fistula resection were all higher than that before surgery(P<0.05),while the maximum anal systolic pressure was not significantly different from that before surgery(P>0.05).After high anal fistula incision and hanging,the rectal resting pressure was higher than that before the operation,and the anal resting pressure and anal relaxation were lower than that before the operation(P<0.05),but there was no significant difference compared with the anal maximum systolic pressure before the operation(P>0.05).Conclusion:The application effect of anorectal pressure measurement before and after surgery for anorectal diseases is significant,which can accurately judge the surgical effect and patients’recovery,and lays a good foundation for further diagnosis and treatment of physicians.