目的 评价采用圆形吻合器治疗直肠黏膜脱垂的安全性和可行性. 方法 回顾性分析2002年10月至2006年1月我院手术治疗的42例直肠黏膜脱垂患者的临床资料,其中直肠内黏膜脱垂22例,直肠外黏膜脱垂20例,均经排粪造影诊断. 结果 42例均行经肛门直肠黏膜环切术(procedure for prolapse and haemorrhoids,PPH),术后随访2～40个月,2例术后半年少量便血,肠镜检查为吻合口丝线缝合处肉芽生长所致.总有效率为88.1%(37/42),其中直肠内黏膜脱垂有效率为81.8%(18/22),直肠外黏膜脱垂有效率达95.0%(19/20). 结论 PPH术治疗直肠外黏膜脱垂优于直肠内黏膜脱垂,手术简便.
目的 探讨改道置管肛外引流术治疗直肠黏膜下脓肿的临床疗效。 方法 2007年5月－2012年5月，将76例直肠黏膜下脓肿患者分为改道置管肛外引流术（治疗组）和传统切开引流术（对照组）治疗，每组各38例，两组患者在年龄、性别比、病程等方面具有可比性。观察两组患者治愈时间、治愈率、随访3个月的复发情况以及肛门直肠压力测定，评价两组患者临床疗效及肛门功能保护情况。 结果 治疗组患者治愈时间为（21.3 ± 6.37）d，对照组为（29.5 ± 4.52）d，治疗组时间明显缩短（t=5.79，P＜0.01）；治疗组治愈率97.3%，对照组为73.6%，差异有统计学差异（χ2=6.81，P＜0. 01）；两组患者随访3个月的肛门功能比较，RRP治疗组为3.48 ± 0.61，对照组3.22 ± 0.79，差异无统计学意义（t=−1.61，P＞0.05）；ARP治疗组为19.05 ± 3.76，对照组为17.55 ± 3.31，差异无统计学意义（t=−1.85，P＞0.05）；ALCT治疗组为36.74 ± 4.70，对照组为37.13 ± 3.90，差异无统计学意义（t=−0.39，P＞0.05）；AMCP治疗组为24.03 ± 5.80，对照组为21.8 ± 4.91，差异无统计学意义（t=−1.61，P＞0.05）。 结论 改道置管肛外引流术治疗直肠黏膜下脓肿可缩短疗程，提高治愈率。
Objective To compare the therapeutic effect of procedure for prolapse and hemorrhoids （PPH） and Block repair procedure for rectocele．Methods A retrospective study of 62 patients with surgical treatment for rectocele was analyzed．The patients were divided into PPH group （n=32） and Block group （n=30） according to the different operation procedure．The symptoms score of improvement of the patients after surgery was compared between the two groups， including operation time，intraoperative blood loss， postoperative pain score， required analgesic times， postoperative complications，hospitalization time，and hospitalization expenses．Results The symptoms of constipation of patients in two groups was significantly improved afer operation．Comparing one month with three months of Longo’s obstructed defecation syndrome （ODS） score after the operation，there was no significant difference in the PPH group（P＞0.05）， but significant difference in the Block group（P＜0.01）．Although the expenses of the PPH group was much higher than that of the Block group （P＜0.01）， the outcomes of the PPH group were much better than those of the Block group （P＜0.01）， including the postoperative Longo’s ODS score of one month and three months，operation time，intraoperative blood loss， postoperative pain score，required analgesic times，and hospitalization time．Two cases of lightly postoperative incontinence occurred in the PPH group，but completely recovered after three months in the clinical follow-up．Conclusions The PPH is as safe and effective as Block repair procedure for rectocele. The short time effect and lower recurrence rate of the PPH are better than those of the Block repair procedure．
目的 探讨吻合器痔上黏膜环切术（PPH）的操作技巧、临床疗效及并发症。方法 根据患者具体情况，采用PPH术个性化治疗重度痔病患者128例，分析其手术操作技巧与临床疗效及术中、术后并发症的关系。结果 手术持续时间平均为30min，切除组织宽度平均为3.5cm。术中出血58例，其中渗血42例，搏动性出血16例。术后出血5例，吻合口感染1例；无大便失禁、吻合口狭窄。术后6个月随访，106例外脱痔块完全回缩，7例回缩不全，15例失访。结论 PPH术已被初步证明是一种微创、安全、有效的手术，但尚需进一步的经验积累及大规模临床试验加以验证。
目的 比较改良外剥内扎术与传统外剥内扎术（Milligan-Morgan手术，MM手术）治疗混合痔的疗效。方法 我院2004年3月至2007年11月期间收治了96例混合痔患者，按抽签法随机均分成了改良外剥内扎术组（改良组）和传统外剥内扎术组（传统组）2组，对2组患者的疗效和并发症进行比较。结果 改良组42例患者治愈，6例好转； 传统组30例患者治愈，16例好转，2例未愈，2组比较差异有统计学意义（Plt;0.05）。改良组患者术中出血量〔(15.4±2.8) ml〕少于传统组〔(25.6±3.3) ml〕，Plt;0.05； 手术时间〔(40.2±5.3) min〕也短于传统组〔(70.5±4.8) min〕，Plt;0.05。改良组患者术后疼痛轻于传统组，并发症也少于传统组，差异均有统计学意义（Plt;0.05）。改良组患者住院时间〔(12.45±2.25) d〕明显短于传统组患者〔(18.69±2.72) d〕，Plt;0.05。2组患者随访20～27个月（平均2年），仅传统组1例复发。结论 改良外剥内扎术的疗效好于传统外剥内扎术。
ObjectiveTo analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. MethodsA historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. ResultsThe operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ2=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.