CAJ | 학술논문

目的：观察两种不同的荷包缝合方法在吻合器痔上黏膜环切术（procedure for pro-lapse and hemorrhoids，PPH）中的效果。方法采用改良单荷包缝合法或双荷包双圈缝合法对80例Ⅲ、Ⅳ度痔患者行PPH术，并比较两组的平均手术时间、切除黏膜宽度及完整性、痔团回缩效果、吻合口出血、术后并发症、复发等数据。结果切除环形黏膜的完整性、痔回缩效果、平均住院时间及复发情况两组间差异无统计学意义（P＞0．05），但双荷包组切除黏膜宽度优于改良单荷包组（P＜0．05），平均手术时间、吻合口出血情况改良单荷包组优于双荷包组（P ＜0．05）；术后疼痛、水肿、切口出血、肛门不适感或狭窄等并发症均差异无统计学意义（P＞0．05），但双荷包组中更容易发生术后首次排便出血的情况（P＜0．05）。结论对于一般中重度痔患者，采用改良单荷包缝合可以达到良好的治疗效果并明显缩短手术时间，但对于痔团脱出严重的患者仍建议使用双荷包缝合以求切除足够的痔上黏膜，起到更明显的悬吊效果。
목적：관찰량충불동적하포봉합방법재문합기치상점막배절술（procedure for pro-lapse and hemorrhoids，PPH）중적효과。방법채용개량단하포봉합법혹쌍하포쌍권봉합법대80례Ⅲ、Ⅳ도치환자행PPH술，병비교량조적평균수술시간、절제점막관도급완정성、치단회축효과、문합구출혈、술후병발증、복발등수거。결과절제배형점막적완정성、치회축효과、평균주원시간급복발정황량조간차이무통계학의의（P＞0．05），단쌍하포조절제점막관도우우개량단하포조（P＜0．05），평균수술시간、문합구출혈정황개량단하포조우우쌍하포조（P ＜0．05）；술후동통、수종、절구출혈、항문불괄감혹협착등병발증균차이무통계학의의（P＞0．05），단쌍하포조중경용역발생술후수차배편출혈적정황（P＜0．05）。결론대우일반중중도치환자，채용개량단하포봉합가이체도량호적치료효과병명현축단수술시간，단대우치단탈출엄중적환자잉건의사용쌍하포봉합이구절제족구적치상점막，기도경명현적현조효과。
Objectives To explore the clinical efficacy of two different kinds of purse-string su-tures in procedure for prolapse and hemorrhoids(PPH).Methods Eighty patients with hemorrhoid(stageⅢand Ⅳ)were treated with improved single purse-string or double purse-string suture for PPH.Mean op-erative time,width and integrity of excised rectum mucosal ring,prolapsed hemorrhoid,anastomotic bleed-ing,complication and recurrence were analyzed between groups.Result There were no significant differ-ences in the integrity of excised rectum mucosal ring,prolapsed hemorrhoid,mean hospital stay and recur-rence.The width of excised rectum mucosal ring in the double purse-string suture group was significantly superior to that in the other group(P<0.05),while improved single purse-string suture had more advanta-ges in prolapsed hemorrhoid correction,mean operative time and anastomotic bleeding.No significant difference was observed in complications,such as postoperative pain,edema,bleeding at incision,anus dis-comfort and stenosis(P>0.05).Patients with double purse-string suture were more likely to bleed during their first defecation(P<0.05 ).Conclusion For patients with stageⅢ and Ⅳ hemorrhoids,improved single purse-string suture can achieve good therapeutic effects.For patients with serious prolapsed hemor-rhoid,double purse-string suture is recommendable because it can excise rectum mucosa sufficiently and a-chieve good effects in suspension.