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中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (05) : 472 -475. doi: 10.3877/cma.j.issn.2095-3224.2018.05.013

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经肛吻合器直肠部分切除术治疗重度脱垂性痔病的临床研究
张正国1, 杨勇1, 杨光1,(), 梁春晖1, 李姗姗1   
  1. 1. 221009 江苏省徐州市中心医院肛肠科
  • 收稿日期:2017-05-23 出版日期:2018-10-25
  • 通信作者: 杨光

Clinical research of tissue selecting therapy stapler stapled transanal rectal resection plus for severe prolapsed hemorrhoids

Zhengguo Zhang1, Yong Yang1, Guang Yang1,(), Chunhui Liang1, Shanshan Li1   

  1. 1. Department of Colorectal Surgery, Xuzhou City Centre Hospital, Xuzhou 221009, China
  • Received:2017-05-23 Published:2018-10-25
  • Corresponding author: Guang Yang
  • About author:
    Corresponding author: Yang Guang, Email:
引用本文:

张正国, 杨勇, 杨光, 梁春晖, 李姗姗. 经肛吻合器直肠部分切除术治疗重度脱垂性痔病的临床研究[J/OL]. 中华结直肠疾病电子杂志, 2018, 07(05): 472-475.

Zhengguo Zhang, Yong Yang, Guang Yang, Chunhui Liang, Shanshan Li. Clinical research of tissue selecting therapy stapler stapled transanal rectal resection plus for severe prolapsed hemorrhoids[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(05): 472-475.

目的

评估经肛吻合器直肠部分切除术治疗重度脱垂性痔病的安全性及有效性。

方法

2013年10月至2015年4月,运用经肛吻合器直肠部分切除术治疗重度脱垂性痔病48例。记录所有患者手术相关指标、围手术期并发症、住院时间及患者满意度,判断总疗效。

结果

48例患者全部顺利完成手术,手术时间平均23.5 min;切除标本宽度平均4.8 cm、体积9.6 ml;26例术中吻合口出血行跨吻合口"8"字缝扎,平均缝扎1.7个点。术后17例出现排尿障碍,其中11例予以药物口服,6例留置导尿。术后当日疼痛评分2.5分,首次排便疼痛评分3.8分;肛门坠胀感评分2.9分;肛门控便功能,术后7天,CCF-FIS评分平均2.3分。住院时间平均7.2天。术后6个月患者满意度9.8分;随访31.3个月,无痔核脱出发生,总有效率100%。

结论

经肛吻合器直肠部分切除术治疗重度脱垂性痔病是安全、有效的。

Objective

To assess the safety, efficacy and feasibility of stapled transanal procedures performed by a new dedicated device, TST STARR Plus, in the treatment of severe prolapsed hemorrhoids.

Methods

From October 2013 to April 2015, Forty-eight patients were enrolled in the study. The procedure with perioperative complications, postoperative complications, the patient′s satisfaction with the efficacy of operation, and recurrence rate were reported.

Results

All patients were successfully performed in the mean of 23.5 minutes. The mean resected volume was 9.6 ml with a mean height of surgical specimen of 4.8 cm. In 26 pts, additional stitches on the suture line were needed (mean 1.7). Postoperative urinary dysfunction was reported in 17 pts, including 11 pts of oral drugs, 6 pts with indwelling catheter. Postoperative pain score of 2.5 points on the surgery day, the first defecation pain score of 3.8 points, the mean tenesmus scoring 2.9 points, CCF-FIS score mean of 2.3 points after 7 days surgery. The mean hospital stay was 7.2 days. The patient′s satisfaction with the efficacy of operation was 9.8 after 6 months, no recurrence of prolapse was reported at a median of 31.3 months after surgery.

Conclusion

TST STARR plus seems to be safe and effective in the treatment of severe prolapsed hemorrhoids.

图1 TST STARR+治疗重度脱垂痔要点。1A插入CAD查看组织脱垂情况;1B在脱垂组织最低平面(2、4、6、8、10、12点)作降落伞式荷包缝合;1C吻合器头部置入CAD内,缝合线分别从开口视窗内由带线器引出,根据痔核脱垂严重情况,从视窗内调整牵拉相应点位缝线的力度和方向,充分牵拉脱垂组织并切除;1D退出吻合器,查看脱垂组织切除情况;1E切除组织标本
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