改良DGHAL术式对痔的临床疗效

发布时间：2018-05-13 21:13

本文选题：痔疮 + 多普勒　；参考：《大连医科大学》2017年硕士论文

【摘要】：研究背景:使用常规痔疮切除术治疗痔疮有显着的发病率,主要的表现为手术后的疼痛及日常活动的延迟。多普勒引导痔疮动脉血管结扎术是治疗痔疮侵入性最小的手术,并可减少患者的不便。研究目的:分析多普勒引导痔疮动脉血管结扎术的最初结果与直肠黏膜治疗痔疮的关联性。研究方法:从2015年12月至2016年8月分析了84例使用多普勒引导痔疮动脉血管结扎术(Doppler-guided hemorrhoidal artery ligation,DGHAL)治疗的患者,包含了第II期,第III期和第IV期痔疮患者。22例患者(26%)为第II期;42例患者(50%)为第III期;和20例患者(24%)为第IV期痔疮患者。所有患者皆由相同的外科医生在脊髓麻醉下使用相同的设备和技术进行手术。这84位病患接受了连续缝合直肠黏膜术结扎6条动脉分支。18名患者需要同时切除肛周赘肉。在术后,评估以下参数:疼痛,里急后重感,出血,瘙痒,脱垂,黏液排出和复发。平均术后持续追踪4个月。研究结果:85.7%的患者最常见的术后抱怨是有里急后重感,其次是疼痛占28.6%,肛门周围烧灼感占12.3%,黏液分泌和肛门周围血肿占4.7%。两名患者出现严重的术后出血,需要手术止血,其中一位还需要输血。95%的患者表示对此手术方式感到满意。研究结论:尽管DGHAL具有与其他手术方法类似的并发症,但其结果显示手术后疼痛较少,更快的复原和恢复工作。更多的病例和更长的追踪研究是必要的,以评估晚期复发。
[Abstract]:Background: conventional hemorrhoidectomy has a significant incidence of hemorrhoids. The main manifestations of hemorrhoidectomy are postoperative pain and delay in daily activities. Doppler-guided ligation of hemorrhoids artery is the least invasive operation for hemorrhoids and can reduce the inconvenience of patients. Objective: to analyze the relationship between the initial results of Doppler-guided hemorrhoids artery ligation and rectal mucosal treatment of hemorrhoids. Methods: from December 2015 to August 2016, 84 patients with Doppler guided hemorrhoid artery ligation (Doppler-guided hemorrhoidal artery ligation) were analyzed, including phase II. 22 patients with hemorrhoids in stage III and IV, 42 patients with stage II and 50 patients with III, and 20 patients with hemorrhoids of stage IV were diagnosed as patients with hemorrhoids of stage IV. All patients were operated by the same surgeon under spinal anesthesia using the same equipment and techniques. The 84 patients underwent continuous rectal mucosal suture and ligation of 6 arterial branches. 18 patients underwent simultaneous excision of perianal vegetations. After surgery, the following parameters are evaluated: pain, severe irritation, bleeding, itching, prolapse, mucus excretion, and recurrence. The average postoperative follow-up lasted 4 months. Results the most common postoperative complaints in 85.7% of the patients were acute and severe, followed by pain, perianal burning, and mucus secretion and perianal hematoma, accounting for 4.7% of the patients, followed by pain (28.6%), perianal burning (12.3%), mucus secretion and perianal hematoma (4.7%). Two patients suffered severe postoperative bleeding and needed surgery to stop the bleeding. One patient also needed a blood transfusion. 95 percent of the patients said they were satisfied with the procedure. Conclusion: although DGHAL has complications similar to other surgical procedures, the results show that there is less postoperative pain and faster recovery and recovery. More cases and longer follow-up studies are necessary to assess late recurrence.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.18

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