本文關(guān)鍵詞： TST術(shù) 混合痔 吻合口位置　出處：《成都中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過對比研究,探索選擇性痔上粘膜切除吻合術(shù)(tissue-selecting therapy,TST)吻合口位置高低的臨床療效異同,為臨床手術(shù)提供選擇依據(jù)。方法：回顧總結(jié)120例符合納入標(biāo)準(zhǔn)的進(jìn)行TST術(shù)的混合痔患者,按照吻合口距離齒線的位置分為高位吻合組[A組(齒線上3cm以上)]40例、中等位置吻合組[B組(齒線上2-3cm)]40例、低位吻合組[C組(齒線上2cm以內(nèi))]40例,通過觀察三組患者吻合口出血、手術(shù)時間、術(shù)后肛緣切口數(shù)量、肛門墜脹感、急便感、肛門疼痛、術(shù)后出血、排尿障礙等情況來比較三種吻合口位置高度的臨床療效,應(yīng)用統(tǒng)計學(xué)軟件SPSS19.0進(jìn)行分析,以α=0.05為水準(zhǔn)進(jìn)行雙側(cè)檢驗。結(jié)果：三組患者吻合口出血、術(shù)后肛緣切口數(shù)量、肛門墜脹感、急便感等方面存在統(tǒng)計學(xué)差異(P0.05)。而在手術(shù)時間、術(shù)后肛門疼痛、術(shù)后出血、排尿障礙、療效評價等方面無統(tǒng)計學(xué)差異(P0.05)。結(jié)論：高位吻合(A組)：吻合口遠(yuǎn)離齒線區(qū)域,對分布于齒線上區(qū)的神經(jīng)和血管損傷少,吻合口出血、急便感、肛門墜脹感等并發(fā)癥較輕。但是吻合口位置過高,對肛墊的提升效果不明顯,殘留的痔核需要配合外剝內(nèi)扎術(shù),術(shù)后肛緣切口多、肛門疼痛較明顯。中等位置吻合(B組)：吻合口距離齒線適中,對齒線上區(qū)及肛墊組織的損傷不明顯,吻合口出血、急便感、肛門墜脹等并發(fā)癥較輕。而且吻合口位置適中,對肛墊有明顯提升效果,需要進(jìn)行外剝內(nèi)扎的痔核較少,術(shù)后肛緣切口少,因而導(dǎo)致的肛門疼痛、肛門墜脹感較輕。低位吻合(C組)：吻合口位于齒線上區(qū)附近,會損傷分布于此的神經(jīng)和血管。術(shù)后吻合釘存在時間較長,對周圍的感覺神經(jīng)刺激明顯,吻合口出血、急便感、肛門墜脹感明顯,嚴(yán)重影響患者術(shù)后生活質(zhì)量。但是低位吻合對肛墊的提升效果最好,吻合后基本無痔核殘留,無需進(jìn)行外剝內(nèi)扎處理,術(shù)后肛緣切口少,因此導(dǎo)致的肛門疼痛最輕。綜合來說,中等位置吻合組(B組),對肛墊提升效果明顯,術(shù)后并發(fā)癥輕,進(jìn)行TST術(shù)時將吻合口位置設(shè)定在齒線上2-3cm較為合理。
[Abstract]:Objective: to explore the clinical curative effect of selective hemorrhoidectomy and anastomosis on the location of the anastomotic site of tissue-selective therapeutic therapy (TST). Methods: one hundred and twenty patients with mixed hemorrhoids who met the standard of TST were retrospectively analyzed. According to the distance from the anastomotic stoma to the dentate line, 40 patients were divided into high anastomosis group [group A (3 cm above tooth line)]. There were 40 cases of middle position anastomosis group [B group (2-3cm above tooth line)] and 40 cases of low anastomosis group [C group (2cm above tooth line)]. To compare the clinical efficacy of the three kinds of anastomotic site height, the results of postoperative bleeding and urination disorder were analyzed by the statistical software SPSS19.0, and the bilateral tests were carried out at the level of 偽 0. 05. Results: the number of postoperative anal margin incisions and bleeding of anastomotic stoma in the three groups were compared. There were significant differences in the sense of anal drop and distension, the sense of acute stool and so on. However, in the operation time, postoperative anal pain, postoperative bleeding, dysuria, and so on, there were significant differences in the operation time, postoperative anal pain, urination disorder, etc. Conclusion: high anastomosis group A is located far from the dentate line area, and has less nerve and blood vessel injury, bleeding in the anastomotic stoma site, and a sense of urgency in the upper dentate area, and there is no statistical difference in the evaluation of curative effect between the two groups (P < 0.05), conclusion: the anastomotic site is located far away from the dentate line in group A. The complications such as anal drop and distention were mild. However, the location of anastomotic site was too high, the effect of anal pad lifting was not obvious, the residual hemorrhoids needed to be combined with external exfoliation and internal ligation, and there were more incisions at the anal margin after operation. Anus pain was obvious. Moderate anastomosis group B: the distance between anastomotic stoma and dentate line was moderate, the injury to the upper area of tooth line and anal pad tissue was not obvious, the complications such as anastomotic bleeding, acute stool feeling, anal drop distention and so on were mild, and the anastomotic site was moderate. The effect on anal pad was obviously improved. There were fewer hemorrhoids and fewer incisions at the anal margin after operation, which resulted in anal pain and less anus distention. Low anastomosis group C: the anastomosis was located near the upper tooth line. The nerve and blood vessels that are located here will be damaged. The anastomotic nail has a long time after operation. It has obvious stimulation to the sensory nerve around it, bleeding from the anastomotic stoma, a sense of urgency, a sense of anal drop and distension. But low anastomosis is the best way to improve anal cushion. After anastomosis, there is no residual hemorrhoids, no external exfoliation and internal ligation is needed, and there is less incision in the anal margin after operation, so the anal pain is the least. In group B of middle position anastomosis, the effect of anal pad lifting was obvious, and the complications were light after operation. It was reasonable to set the anastomotic site at 2 ~ 3 cm above the tooth line during TST operation.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.18

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