选择性痔上黏膜切除吻合术吻合口位置高低的临床疗效观察

发布时间：2018-02-11 06:44

本文关键词： TST术混合痔吻合口位置　出处：《成都中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过对比研究,探索选择性痔上粘膜切除吻合术(tissue-selecting therapy,TST)吻合口位置高低的临床疗效异同,为临床手术提供选择依据。方法：回顾总结120例符合纳入标准的进行TST术的混合痔患者,按照吻合口距离齿线的位置分为高位吻合组[A组(齿线上3cm以上)]40例、中等位置吻合组[B组(齿线上2-3cm)]40例、低位吻合组[C组(齿线上2cm以内)]40例,通过观察三组患者吻合口出血、手术时间、术后肛缘切口数量、肛门坠胀感、急便感、肛门疼痛、术后出血、排尿障碍等情况来比较三种吻合口位置高度的临床疗效,应用统计学软件SPSS19.0进行分析,以α=0.05为水准进行双侧检验。结果：三组患者吻合口出血、术后肛缘切口数量、肛门坠胀感、急便感等方面存在统计学差异(P0.05)。而在手术时间、术后肛门疼痛、术后出血、排尿障碍、疗效评价等方面无统计学差异(P0.05)。结论：高位吻合(A组)：吻合口远离齿线区域,对分布于齿线上区的神经和血管损伤少,吻合口出血、急便感、肛门坠胀感等并发症较轻。但是吻合口位置过高,对肛垫的提升效果不明显,残留的痔核需要配合外剥内扎术,术后肛缘切口多、肛门疼痛较明显。中等位置吻合(B组)：吻合口距离齿线适中,对齿线上区及肛垫组织的损伤不明显,吻合口出血、急便感、肛门坠胀等并发症较轻。而且吻合口位置适中,对肛垫有明显提升效果,需要进行外剥内扎的痔核较少,术后肛缘切口少,因而导致的肛门疼痛、肛门坠胀感较轻。低位吻合(C组)：吻合口位于齿线上区附近,会损伤分布于此的神经和血管。术后吻合钉存在时间较长,对周围的感觉神经刺激明显,吻合口出血、急便感、肛门坠胀感明显,严重影响患者术后生活质量。但是低位吻合对肛垫的提升效果最好,吻合后基本无痔核残留,无需进行外剥内扎处理,术后肛缘切口少,因此导致的肛门疼痛最轻。综合来说,中等位置吻合组(B组),对肛垫提升效果明显,术后并发症轻,进行TST术时将吻合口位置设定在齿线上2-3cm较为合理。
[Abstract]:Objective: to explore the clinical curative effect of selective hemorrhoidectomy and anastomosis on the location of the anastomotic site of tissue-selective therapeutic therapy (TST). Methods: one hundred and twenty patients with mixed hemorrhoids who met the standard of TST were retrospectively analyzed. According to the distance from the anastomotic stoma to the dentate line, 40 patients were divided into high anastomosis group [group A (3 cm above tooth line)]. There were 40 cases of middle position anastomosis group [B group (2-3cm above tooth line)] and 40 cases of low anastomosis group [C group (2cm above tooth line)]. To compare the clinical efficacy of the three kinds of anastomotic site height, the results of postoperative bleeding and urination disorder were analyzed by the statistical software SPSS19.0, and the bilateral tests were carried out at the level of 伪 0. 05. Results: the number of postoperative anal margin incisions and bleeding of anastomotic stoma in the three groups were compared. There were significant differences in the sense of anal drop and distension, the sense of acute stool and so on. However, in the operation time, postoperative anal pain, postoperative bleeding, dysuria, and so on, there were significant differences in the operation time, postoperative anal pain, urination disorder, etc. Conclusion: high anastomosis group A is located far from the dentate line area, and has less nerve and blood vessel injury, bleeding in the anastomotic stoma site, and a sense of urgency in the upper dentate area, and there is no statistical difference in the evaluation of curative effect between the two groups (P < 0.05), conclusion: the anastomotic site is located far away from the dentate line in group A. The complications such as anal drop and distention were mild. However, the location of anastomotic site was too high, the effect of anal pad lifting was not obvious, the residual hemorrhoids needed to be combined with external exfoliation and internal ligation, and there were more incisions at the anal margin after operation. Anus pain was obvious. Moderate anastomosis group B: the distance between anastomotic stoma and dentate line was moderate, the injury to the upper area of tooth line and anal pad tissue was not obvious, the complications such as anastomotic bleeding, acute stool feeling, anal drop distention and so on were mild, and the anastomotic site was moderate. The effect on anal pad was obviously improved. There were fewer hemorrhoids and fewer incisions at the anal margin after operation, which resulted in anal pain and less anus distention. Low anastomosis group C: the anastomosis was located near the upper tooth line. The nerve and blood vessels that are located here will be damaged. The anastomotic nail has a long time after operation. It has obvious stimulation to the sensory nerve around it, bleeding from the anastomotic stoma, a sense of urgency, a sense of anal drop and distension. But low anastomosis is the best way to improve anal cushion. After anastomosis, there is no residual hemorrhoids, no external exfoliation and internal ligation is needed, and there is less incision in the anal margin after operation, so the anal pain is the least. In group B of middle position anastomosis, the effect of anal pad lifting was obvious, and the complications were light after operation. It was reasonable to set the anastomotic site at 2 ~ 3 cm above the tooth line during TST operation.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.18

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