吻合器痔环切术治疗环状脱垂性内痔吻合口部位选择的临床价值

目的 通过对痔吻合器环切术吻合口与齿线间距离变化所对应的各个临床指标变化的比较分析,研究吻合口与齿线间距离选择在Ⅲ～Ⅳ度环状脱垂性内痔临床治疗上的意义. 方法对106例Ⅲ～Ⅳ度环状脱垂性内痔患者行吻合器痔环切术,术中测定吻合口与齿线间距离,术后对各患者各项临床指标(包括排便失禁评分、术后疼痛评分、出血、肛缘水肿、残留皮赘等局部并发症以及满意度)进行统计,研究分析吻合口齿线间距离对临床指标的影响,探讨吻合口齿线间距离的选择在吻合器痔环切术治疗中的意义. 结果根据测得的吻合口与齿线间距离将106例患者分成4组,其中吻合口与齿线间距离小于1.0 cm为A组,有20例,在1.0～1.5 cm间为B组,有40例,在1.5～2.0 cm间为c组,有37例,距离大于2.0 cm为D组,有9例.4组在术后Wexner肛门失禁评分、肛门出血评分、肛门局部并发症评分、满意度评分上无差别,在术后疼痛评分4组之间有显著差异,A组术后早期的疼痛较其余3组明显. 结论应用吻合器痔环切术治疗Ⅲ～Ⅳ度环状脱垂性内痔时,针对痔不同的脱垂程度选择适宜的吻合口部位,临床治疗效果良好.

Stapled haemorrhoidectomy in the choice of anastomosis site in patients with severe circumferential prolapsed haemorrhoids

Objective To explore the correlation of the distance between anastomosis and dentate line in patients with severe circumferential prolapsed haemorrhoids treated by stapled haemorrhoidectomy with the patients' postoperative clinical manufestival score, and assess its value in the choice of anastomosis site in stapled haemorrhoidectomy. Methods One hundred and six patients with severe circumferential prolapsed haemorrhoids was treated by stapled haemorrhoidectomy. The distance between anastomosis and dentate line was documented during the operation, effect of the treatment and complications were also documented postoperatively. All above-mentioned data were analysed statisticaly by one-way ANOVA and ridit test.Results Four groups were established in 106 patients according to the distance between anastomosis and dentate line. Patients with distance less than 1.0cm were defined as group A, between 1.0 cm and 1.5 cm as group B, between 1.5 cm and 2.0 cm as group C, more than 2.0 cm as group D. Concerning the postoperative incontinence score, satisfaction index and complications such as haemorrhage,ederma of anal everage,residal skin-tags, there was no significant difference between all groups. But there was significant difference between four groups in score of pain. Conclusions Patients with severe circumferential prolapsed haemorrhoids treated by Stapled haemorrhoidectomy tend to have good clinical outcome. The appropriate distance between anastomosis and dentate line should be chosed by the status of prolapsed haemorrhoids.