目的 探討在局部麻醉下行痔上黏膜環(huán)形切除釘合術(shù)(procedure for prolapse and hemorrhoids,PPH)治療重度內(nèi)痔的可行性及臨床應(yīng)用價(jià)值。
方法 筆者所在醫(yī)院科室從2005年起對32例Ⅲ度及Ⅳ度脫垂性內(nèi)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(huán)形局部浸潤麻醉行PPH術(shù),對其麻醉效果、手術(shù)時(shí)間、術(shù)中及術(shù)后疼痛、尿潴留、術(shù)后感染、肛門狹窄、住院時(shí)間、治療滿意度等進(jìn)行分析。
結(jié)果 32例患者均順利完成手術(shù),有1例術(shù)中改行低位連續(xù)硬膜外麻醉,1例輔加鎮(zhèn)靜劑及鎮(zhèn)痛劑。術(shù)后28例對疼痛能耐受,4例需鎮(zhèn)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(shù)后感染、出血、肛門狹窄等并發(fā)癥發(fā)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(shí)間3~6d,平均4d。32例患者均進(jìn)行有效隨訪,隨訪時(shí)間2~4個(gè)月,平均3個(gè)月,無大便失禁或復(fù)發(fā),肛門控便能力均可。
結(jié)論 局部麻醉下行PPH術(shù)治療重度內(nèi)痔是一種安全可行的手術(shù)方法,麻醉操作護(hù)理簡單,療效確切,術(shù)后并發(fā)癥少,術(shù)后恢復(fù)快,并可減少醫(yī)療費(fèi)用。
引用本文: 能克武,李靜,董云玉,李彥錕,陳大巧. 局部麻醉下行PPH術(shù)治療重度內(nèi)痔32例報(bào)道. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(4): 455-457. doi: 復(fù)制
1. | Longo A. Treatment of hemorrhoidal disease by reduction of mucosaand hemorrhoidal prolase with a circular suturing device:a new proeedure[M]. Rome, Italy:Monduzzi Editore. 1998:3-5. |
2. | Thompson WHF. The nature of haemorrhoids[J]. Br J Surg, 1975, 62(7):542-552. |
3. | 吳階平, 裘法祖主編. 黃家駟外科學(xué)[M]. 第6版. 北京:人民衛(wèi)生出版社, 2005:1159-1160. |
4. | Braini A, Narisetty P, Favero A, et a1. Double PPH technique for hemorrhoidal prolapse:A multicentric, prospective, and nonran-domized trial[J]. Surg Innov, 2013 Jan 20. [Epub ahead of print]. |
5. | Arezzo A, Podzemny V, Pescatori M. Surgical management of hemorrhoids. State of the art[J]. Ann Ital Chir, 2011, 82(2):163-172. |
6. | Ko?orok P. Our criteria for PPH procedure in one day surgery practice[J]. Tech Coloproctol, 2010, 14 Suppl 1:S9-S11. |
7. | Festen S, van Hoogstraten MJ, van Geloven AA, et a1. Treatment of gradeⅢandⅣhaemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results[J]. Int J Colorectal Dis, 2009, 24(12):1401-1405. |
8. | Khubchandani I, Fealk MH, Reed JF 3rd. Is there a post-PPH syndrome?[J]. Tech Coloproctol, 2009, 13(2):141-144. |
9. | Pescatori M, Gagliardi G. Postoperative complications afterprocedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures[J]. Tech Coloproctol, 2008, 12(1):7-19. |
10. | Fazio VW. Early promise of stapling technique for haemorrhoidectomy[J]. Lancet, 2000, 355(9206):768-770. |
11. | Ganio E, Ahomanre DF, Gabrielli F, et a1. Prospective randomized muhieentre trial comparing stapled with open haemorrhoidectomy[J]. Br J Surg, 2001, 88(5):669-671. |
12. | Singer MA, Cintron JR, Fleahman JW, et al. Early experience with stapled hemorrhoidectomy in the United States[J]. DisColon Rectum, 2002, 45(3):360-369. |
13. | 蘇冀. 環(huán)狀混合痔吻合器痔上黏膜環(huán)切術(shù)后并發(fā)癥的處理及預(yù)防[J]. 中國現(xiàn)代醫(yī)學(xué)雜志, 2009, 19(16):2521-2526. |
14. | Esser S, Khubchandani I, Rakhmanie M. Stapled hemorrhoidectomy with local anesthesia can be performed safely and cost-efficiently[J]. Dis Colon Rectum, 2004, 47(7):1164-1169. |
15. | 美雄, 蘇偉, 肖剛, 等. 陰部神經(jīng)阻滯麻醉的解剖學(xué)基礎(chǔ)[J]. 結(jié)直腸肛門外科, 2006, 12(5):275-277. |
- 1. Longo A. Treatment of hemorrhoidal disease by reduction of mucosaand hemorrhoidal prolase with a circular suturing device:a new proeedure[M]. Rome, Italy:Monduzzi Editore. 1998:3-5.
- 2. Thompson WHF. The nature of haemorrhoids[J]. Br J Surg, 1975, 62(7):542-552.
- 3. 吳階平, 裘法祖主編. 黃家駟外科學(xué)[M]. 第6版. 北京:人民衛(wèi)生出版社, 2005:1159-1160.
- 4. Braini A, Narisetty P, Favero A, et a1. Double PPH technique for hemorrhoidal prolapse:A multicentric, prospective, and nonran-domized trial[J]. Surg Innov, 2013 Jan 20. [Epub ahead of print].
- 5. Arezzo A, Podzemny V, Pescatori M. Surgical management of hemorrhoids. State of the art[J]. Ann Ital Chir, 2011, 82(2):163-172.
- 6. Ko?orok P. Our criteria for PPH procedure in one day surgery practice[J]. Tech Coloproctol, 2010, 14 Suppl 1:S9-S11.
- 7. Festen S, van Hoogstraten MJ, van Geloven AA, et a1. Treatment of gradeⅢandⅣhaemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results[J]. Int J Colorectal Dis, 2009, 24(12):1401-1405.
- 8. Khubchandani I, Fealk MH, Reed JF 3rd. Is there a post-PPH syndrome?[J]. Tech Coloproctol, 2009, 13(2):141-144.
- 9. Pescatori M, Gagliardi G. Postoperative complications afterprocedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures[J]. Tech Coloproctol, 2008, 12(1):7-19.
- 10. Fazio VW. Early promise of stapling technique for haemorrhoidectomy[J]. Lancet, 2000, 355(9206):768-770.
- 11. Ganio E, Ahomanre DF, Gabrielli F, et a1. Prospective randomized muhieentre trial comparing stapled with open haemorrhoidectomy[J]. Br J Surg, 2001, 88(5):669-671.
- 12. Singer MA, Cintron JR, Fleahman JW, et al. Early experience with stapled hemorrhoidectomy in the United States[J]. DisColon Rectum, 2002, 45(3):360-369.
- 13. 蘇冀. 環(huán)狀混合痔吻合器痔上黏膜環(huán)切術(shù)后并發(fā)癥的處理及預(yù)防[J]. 中國現(xiàn)代醫(yī)學(xué)雜志, 2009, 19(16):2521-2526.
- 14. Esser S, Khubchandani I, Rakhmanie M. Stapled hemorrhoidectomy with local anesthesia can be performed safely and cost-efficiently[J]. Dis Colon Rectum, 2004, 47(7):1164-1169.
- 15. 美雄, 蘇偉, 肖剛, 等. 陰部神經(jīng)阻滯麻醉的解剖學(xué)基礎(chǔ)[J]. 結(jié)直腸肛門外科, 2006, 12(5):275-277.