痔上黏膜环形切除钉合术（PPH）再思考

doi:10.3877/cma.j.issn.2095-3224.2021.05.011

痔上黏膜环形切除钉合术（PPH）为痔的治疗提供了新理念，至今已在临床运用20余年。PPH既有缩短手术时间、术中出血少、术后疼痛轻等显著优势，也伴发一些并发症，诸多评论不一。笔者就PPH治疗脱垂性痔的病理生理学再认识，结合近期远期疗效、术后并发症及技术改进等，了解PPH产生的过程，适应证、禁忌证、并发症、近远期效果，以及国内外结直肠肛门外科医生做出的技术改进，并为以后继续服务于临床做依据。

关键词: 痔, 痔上黏膜环形切除钉合术（PPH）, 病理生理, 临床应用, 改良

Procedure for prolapse and hemorrhoids (PPH) has provided a new idea for the treatment of hemorrhoids, which has been used for more than 20 years. PPH has the advantages of shortening operation time, less bleeding and less postoperative pain, but also has some complications. Based on the further understanding of the pathophysiology of PPH in the treatment of prolapsed hemorrhoids, combined with the short-term and long-term curative effect, postoperative complications and technical improvement, the author understands the process of PPH production, indications, contraindications, complications, short-term and long-term effects, as well as the technical improvement made by colorectal surgeons at home and abroad, and provides the basis for further clinical services.

Key words: Hemorrhoids, PPH, Pathophysiology, Clinical application, Modified

[1]	Longo A. Mechanical hemorrhoidectomy using a circular stapler. Refresher course on hemorrhoidal disease therapy. 24th International Congress of Latin Mediterranean[J]. Palermo: Renna s.p.a. Graphic, 1995.
[2]	AntonioLongo. Stapled anopexy and stapled hemorrhoidectomy: two opposite concepts and procedures[J]. Diseases of the Colon and Rectum, 2002, 45(4): 571-572.
[3]	Longo A. Treatment of haemorrhoids disease by reduction of mucosa and haemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the Sixth World Congress of Endoscopic Surgery Bologna[M]. Monduzzi Editore, 1998: 777-784.
[4]	姚礼庆, 钟芸诗, 任重.吻合器痔上黏膜环切钉合术15年疗效再评估[J]. 中华胃肠外科杂志, 2012, 15(12): 1211-1213.
[5]	陈孝平, 汪建平, 赵继.外科学[M].9版.北京:人民卫生出版社,2018: 404.
[6]	科曼.CORMAN结直肠外科学[M].傅传刚, 汪建平, 王杉主译. 6版, 上海:上海科学技术出版社, 2016: 261-265.
[7]	Allegra G. Esperienze particolari con le suturatrici meccaniche: emorroidectomia con stapler circolare[J]. G Chir, 1990, 11(3): 95-97.
[8]	Thomson WH. The nature of haemorrhoids[J]. Pubmed, 1975, 62(7):542-552.
[9]	傅传刚, 丁健华. 直肠肛管解剖生理新概念[J]. 中国现代手术学杂志, 2003, 7(3): 235-239.
[10]	Boccasanta P, Capretti PG, Venturi M, et al. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse[J]. Am J Surg, 2001, 182(1): 64-68.
[11]	Gaj F, Trecca A. Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey[J]. Tech Coloproctol, 2005, 9(2): 163-165.
[12]	Corman ML, Gravié JF, Hager T, et al. Stapled haemorrhoidopexy: a consensus position paper by an international working party-indications, contra-indications and technique[J]. Colorectal Dis, 2003, 5(4): 304-310.
[13]	杨新庆, 韩进.吻合器痔上黏膜钉合术学术研讨会纪要[J].中华外科杂志, 2002, 40(10): 795.
[14]	中华医学会外科学分会肛肠外科学组.《痔上黏膜环形切除钉合术(PPH)暂行规范》修订[J]. 中华胃肠外科杂志, 2005, 8(4): 342.
[15]	Infantino A, Altomare DF, Bottini C,et al. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids[J].Colorectal Dis, 2012, 14(2): 205-211.
[16]	姚礼庆, 唐竞, 孙益红, 等.经吻合器治疗重度痔的临床应用价值(附36例报告)[J]. 中国实用外科杂志, 2001, 21(5): 34-35.
[17]	任东林, 罗湛滨, 张思奋, 等.吻合器痔上黏膜环切钉合、肛垫复位固定术与外切内扎术治疗Ⅲ°-Ⅳ°痔的比较研究[J].中华普通外科杂志, 2002, 17(12): 714-715.
[18]	Beattie GC, Lam J, Loudon MA. A prospective evaluation of the introduction of circumferential stapled anoplasty in the management of haemorrhoids and mucosal prolapsed[J]. Colorectal Dis, 2000, 2(3): 137-142.
[19]	Hiremath Bharati, Gupta Sandeep. Stapled haemorrhoidopexy for haemorrhoids: a review of our early experience[J]. The Indian Journal of Surgery, 2012, 74(2): 163-165.
[20]	Laughlan K, Jayne DG, Jackson D, et al. Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review[J]. Int J Colorectal Dis, 2009, 24(3): 335-344.
[21]	Shao WJ, Li GC, Zhang ZH, et al. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy[J]. Br J Surg, 2008, 95(2): 147-160.
[22]	Majumder KR, Karmakar R. Short term and long term outcome following stapled haemorrhoidopexy[J]. Mymensingh Med J, 2019,28(4): 866-871.
[23]	Ganio E, Altomare DF, Gabrielli F, et al. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy[J]. Br J Surg, 2001, 88(5): 669-674.
[24]	Ammaturo C, Tufano A, Spiniello E, et al. Stapled haemorrhoidopexy vs. Milligan-Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial[J]. G Chir, 2012, 33(10): 346-351.
[25]	Ashwani Kumar, Manisha Aggarwal, Rachan Lal Singla, et al. Open (Miligan Morgan) haemorrhoidectomy versus stapled haemorrhoidopexy: a comparative study[J]. Journal of Advances in Medicine and Medical Research, 2017: 1-7.
[26]	Lin HC, He QL, Shao WJ, et al. Partial stapled hemorrhoidopexy versus circumferential stapled hemorrhoidopexy for grade III to IV prolapsing hemorrhoids: a randomized, noninferiority trial[J]. Dis Colon Rectum, 2019, 62(2): 223-233.
[27]	朱军, 丁健华, 赵克, 等.吻合器痔上黏膜环切钉合术并发症分析[J]. 中华胃肠外科杂志, 2012, 15(12): 1252-1255.
[28]	Ommer A, Hinrichs J, Möllenberg H, et al. Long-term results after stapled hemorrhoidopexy: a prospective study with a 6-year follow-up[J]. Dis Colon Rectum, 2011, 54(5): 601-608.
[29]	Francesco Ceci, Marcello Picchio, Domenico Palimento, et al. Long-term outcome of stapled hemorrhoidopexy for grade III and grade IV hemorrhoids[J]. Diseases of the Colon and Rectum, 2008, 51(7): 1107-1112.
[30]	Bellio G, Pasquali A, Visconte MS, et al. stapled hemorrhoidopexy: results at 10-year follow-up[J].Diseases of the Colon and Rectum, 2018, 61(4): 491-498.
[31]	周春华, 任华, 蔡维, 等.吻合器痔上黏膜环形切除钉合术治疗重度混合痔的并发症分析[J]. 中华消化外科杂志, 2014, 13(12): 964-966.
[32]	Sturiale A, Fabiani B, Menconi C, et al. Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years[J]. Tech Coloproctol, 2018, 22(9): 689-696.
[33]	张玉茹, 赵团结.痔病PPH术后并发症分析[J].结直肠肛门外科, 2020, 26(3): 284-288.
[34]	陈巍峰, 姚礼庆, 周平红, 等.吻合器痔上黏膜环切钉合术后迟发性大出血的诊治分析[J].中华胃肠外科杂志, 2009, 12(4): 420-421.
[35]	Brusciano L, Ayabaca SM, Pescatori M, et al. Reinterventions after complicated or failed stapled hemorrhoidopexy[J]. Dis Colon Rectum, 2004, 47(11): 1846-1851.
[36]	Cheetham MJ, Mortensen NJ, Nystrom PO, et al. Persistent pain and faecal urgency after stapled haemorrhoidectomy[J]. Lancet, 2000, 356(9231): 730-733.
[37]	杨洁, 杨勇.经肛吻合技术治疗痔病的研究进展[J].结直肠肛门外科, 2019, 25(2): 239-242.
[38]	Brusciano L, Ayabaca SM, Pescatori M, et al. Reinterventions after complicated or failed stapled hemorrhoidopexy[J]. Dis Colon Rectum, 2004, 47(11): 1846-1851.
[39]	周雪涛, 王振军, 郑毅, 等. 痔上黏膜环切术与经肛门直肠切除术的并发症相关因素分析[J]. 中华普通外科杂志, 2016, 31(12): 1011-1014.
[40]	叶明, 谭震, 张延光, 等.吻合器痔上黏膜环切术后并发8例直肠憩室的临床分析[J].中国急救医学, 2017, 37(21): 260.
[41]	Molloy RG, Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy[J]. Lancet, 2000, 355(9206): 810.
[42]	Ripetti V, Caricato M, Arullani A. Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations[J]. Diseases of the Colon and Rectum, 2002, 45(2): 268-270.
[43]	杨向东, 魏雨, 颜景颖.痔PPH术常见并发症防治的研究进展[J].结直肠肛门外科, 2008, 14(2): 127-131.
[44]	McDonald PJ, Bona R, Cohen CR. Rectovaginal fistula after stapled haemorrhoidopexy[J]. Colorectal Dis, 2004, 6(1): 64-65.
[45]	Quevedo-Bonilla G, Farkas AM, Abcarian H, et al. Septic complications of hemorrhoidal banding[J]. Arch Surg, 1988, 123(5): 650-651.
[46]	Barwell J, Watkins RM, Lloyd-Davies E, et al. Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: report of a case[J]. Dis Colon Rectum, 1999, 42(3): 421-423.
[47]	Faucheron JL, Voirin D, Abba J. Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy[J]. Br J Surg, 2012, 99(6): 746-753.
[48]	McCloud JM, Jameson JS, Scott AN. Life-threatening sepsis following treatment for haemorrhoids: a systematic review[J]. Colorectal Dis, 2006, 8(9): 748-755.
[49]	Watson AJ, Hudson J, Wood J, et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial[J]. Lancet, 2016, 388(10058): 2375-2385.
[50]	沈凯, 王畅, 高志冬, 等.吻合器痔上黏膜环切钉合术与经肛门吻合器直肠切除术治疗Ⅳ度混合痔的临床对比研究[J]. 中华胃肠外科杂志, 2019, 22(12): 1165-1169.
[51]	Watson AJ, Cook J, Hudson J, et al. A pragmatic multicentre randomised controlled trial comparing stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease: The eTHoS study[J]. Health Technol Assess, 2017, 21(70): 1-224.
[52]	Cirocco WC. Life threatening sepsis and mortality following stapled hemorrhoidopexy[J]. Surgery, 2008, 143(6): 824-829.
[53]	Mascagni D, Naldini G, Stuto A, et al. Recurrence after stapled haemorrhoidopexy[J].Techniques in Coloproctology, 2015, 19(5): 321-322.
[54]	Lin HC, Lian L, Xie SK, et al. The tissue selecting technique: partial stapled hemorrhoidopexy[J]. Diseases of the Colon and Rectum, 2013, 56(11): 1320-1324.
[55]	Sturiale A, Fabiani B, Menconi C, et al. Correction to: Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years[J]. Techniques in Coloproctology, 2018, 22(9): 733.

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Rethinking on the procedure for prolapse and hemorrhoids

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Rethinking on the procedure for prolapse and hemorrhoids