目的 比較吻合器痔上黏膜環切術(PPH)與傳統痔切除術(Milligan-Morgan,MM)治療混合痔的臨床療效。方法 200例混合痔患者中行PPH和MM治療各100例,比較2組患者的療效及并發癥。結果 PPH在療效及術后并發癥發生方面與MM組比較,差異均無統計學意義(P>0.05)。結論 在治療混合痔方面PPH不優于MM。
【摘要】目的 探討分段整形提縮注射術治療脫肛痔的臨床療效。方法 175例重度環狀痔, 沿肛緣弧形切除結締組織外痔以整形肛門, 再于結扎痔核基底及其上端黏膜下層注射消痔靈注射液,并進行療效觀察。結果 術后肛周水腫(72 h)、疼痛(24及72 h)明顯減少; 術后4周臨床治愈145例,好轉23例,總有效率為96.0%; 所有患者均隨訪3~6個月,未見復發。結論 選擇分段整形提縮注射術既比較徹底地去除了痔核使之不易復發,又整形了肛門,保護其大小和功能, 該術式可成為治療脫肛痔的較理想術式。
目的探討痔切除吻合器痔上粘膜環切術(PPH)的臨床應用價值。方法采用33 mm痔切除吻合器痔上粘膜切除術對嚴重脫垂性痔30例進行治療。結果全組病例平均手術時間10分鐘,術后住院時間1~3天,脫出痔塊均回縮,切除直腸粘膜完整率達98%,術后90%的患者無肛門疼痛,隨訪3個月,28例滿意,2例基本滿意。結論采用痔切除吻合器痔上粘膜環切術治療嚴重脫垂性痔是一種新技術,其手術操作簡單,具有安全、有效、手術時間短、術后疼痛輕、恢復快等特點,有望替代傳統的治療方法。
目的 探討在局部麻醉下行痔上黏膜環形切除釘合術(procedure for prolapse and hemorrhoids,PPH)治療重度內痔的可行性及臨床應用價值。方法 筆者所在醫院科室從2005年起對32例Ⅲ度及Ⅳ度脫垂性內痔(含1例混合痔)患者均采用苯巴比妥+氫溴酸東莨菪堿+利多卡因肛管直腸環形局部浸潤麻醉行PPH術,對其麻醉效果、手術時間、術中及術后疼痛、尿潴留、術后感染、肛門狹窄、住院時間、治療滿意度等進行分析。結果 32例患者均順利完成手術,有1例術中改行低位連續硬膜外麻醉,1例輔加鎮靜劑及鎮痛劑。術后28例對疼痛能耐受,4例需鎮痛藥物;1例患者有肛門墜脹感;所有患者傷口均一期愈合,無尿潴留、術后感染、出血、肛門狹窄等并發癥發生;31例對療效滿意,有1例感肛門墜脹,行溫水坐浴及痔瘡膏納肛治療1周后緩解。住院時間3~6d,平均4d。32例患者均進行有效隨訪,隨訪時間2~4個月,平均3個月,無大便失禁或復發,肛門控便能力均可。結論 局部麻醉下行PPH術治療重度內痔是一種安全可行的手術方法,麻醉操作護理簡單,療效確切,術后并發癥少,術后恢復快,并可減少醫療費用。
摘要:目的:觀察超短波治療對痔術后創面愈合的影響。方法:將100例混合痔術后患者分為治療組和對照組各40例,治療組于術后24小時給予超短波治療和復方紫草油紗條換藥,對照組僅給以復方紫草油紗條換藥,觀察兩組創面愈合時間和創面上皮生長速度。結果:治療組較對照組創面愈合時間更短(Plt;0.01),創面上皮生長速度更快(Plt;0.01)。結論〗:超短波治療能夠加速痔術后創面愈合時間,減少痛苦,療效確切安全。Abstract: Objective: To observe the clinical efficacy of ultrashort wave on the healing of wound after operation for hemorrhoids. Methods: One hundred cases of disease subjected to operation were divided into the treatment group (50 cases) and the control group (50 cases).The treatment group had been given ultrashort wave 24 hours after operation and Fufangzicaoyousa ointment gauze. The control group had been give Fufangzicaoyousa ointment gauze. Results: The results showed that the woundhealing time was much shorter in the treatment group than in the control group (Plt;0.01), the epidermis growth was much faster in the treatment group than in he control group (Plt;0.01). Conclusion: Ultrashort wave can promote the healing of wound after the operation for hemorrhoids and relieve pain, and it can be externally used safely.
目的:總結吻合器痔上黏膜環切術(PPH)治療痔病的經驗。探討該術式的有關問題,以便提高療效。方法:回顧性分析了2001~2006年8月收治痔病541例,其中PPH術42例的臨床資料。本組均為Ⅲ度或Ⅳ度痔。局部合并癥共22例次:血栓外痔愈合后遺留皮贅14例,肛裂2例。有關全身合并癥:前列腺增生7例,慢性泌尿系統感染1例。結果:42例中,35例術后2~5天出院,6例自愿留院到7天,1例慢性尿路感染者術后2~7天多次便血,再次手術后28日痊愈出院。隨訪13~24個月:32例恢復滿意,10例有肛門包塊感及包塊排糞時輕度脫出,其中3例經進一步處理緩解,另7例觀察治療。結論:(1)PPH手術簡單易行,疼痛輕,住院時間短,效果好。(2)為了提高效果術中應注意:①禁忌癥為單個痔塊脫出和肛管皮膚不平滑并纖維化的Ⅳ度病變者外。我們還發現慢性泌尿系統感染未徹底治愈者也應視為相對禁忌。明顯前列腺增生者也應慎重。②術中按經典PPH手術的要求進行操作,擴肛器插入前后,不宜擴肛和下牽痔塊。③個別巨大痔塊及皮贅性痔塊(tag)宜先行切除,再行本術。④重度脫出者,黏膜切除應寬大,必要時切除部分肛墊。
目的 觀察帕瑞昔布鈉超前鎮痛在痔上黏膜環切術中對丙泊酚半數有效效應室靶濃度和對術后視覺模擬評分法(VAS) 的影響。 方法 2010年3月-2011年10月擇期手術患者60例,隨機分為帕瑞昔布組(試驗組)和生理鹽水組(對照組),每組各30例,分別于術前10 min靜脈注射帕瑞昔布鈉40 mg或生理鹽水2 mL。痔上黏膜環切時靶控輸注丙泊酚,其靶控濃度按序貫法確定,相鄰靶濃度之間對數差為0.05。觀察兩組丙泊酚的有效濃度及術后2、4、8、24 h的VAS評分。 結果 試驗組的半數有效效應室靶控濃度(4.30 μg/mL)低于對照組(4.95 μg/mL),差異有統計學意義(P<0.05)。術后4、8、24 h試驗組VAS評分明顯低于對照組,差異有統計學意義(P<0.05)。 結論 帕瑞昔布鈉可以減少術中丙泊酚的用量,并可得到滿意的術后鎮痛效果。
Objective To evaluate treatment of the bleeding and prolapse of hemorrhoids by copper ion electrochemistry.Methods All patients suffered from the bleeding and prolapse of internal hemorrhoids or mixed hemorrhoids were included in this study. There were 202 patients in trial group (79 patients with internal hemorrhoids,123 patients with mixed hemorrhoids). Control group contained 171 cases (64 patients with internal hemorrhoids,107 patients with mixed hemorrhoids). There were 56 patients with prolapse of inner hemorrhoids or mixed hemorrhoids. Copper ion electrochemistry was performed in trial group. Suppository was used in control group. After the rectum was sterilized, the copper needle was inserted into the hemorrhoid with the depth about 8-15 mm. Then we continued the therapy for 4 minutes and 40 seconds. Other hemorrhoids were treated in the same way. Results The cure rate in trial group with hemorrhoidal bleeding was 98.0%,special virtual rate was 1.50%,virtual rate was 0.5%, inefficiency rate was 0 (U=44.6,Plt;0.001). The cure rate in control group was 11.1%,special virtual rate was 24.6%,virtual rate was 28.1%,inefficiency rate was 36.3%. The cure rate of prolapse group was 48.2%,special virtual rate was 33.9%,virtual rate was 17.9%. The patients didn’t feel uncomfortable and recovered 4 hours later after operation. Conclusion This therapy was safe, effective and simple.