Gaj Fabio, Trecca Antonello, Crispino Pietro
Dipartimento di Chirurgia Generale e Trapianti d'Organo, Istituto "Paride Stefanini", Università degli Studi di Roma
Chir Ital. 2009 Sep-Dec;61(5-6):653-8.
Rectocele and haemorrhoidal prolapse are two pathologies that in all cases entail partial excision of anorectal tissue possibly with less invasive surgical procedures. For these pathologies, the authors have recently improved their treatment procedures, introducing the sequential transfixed stitch technique (STST) for rectocele and the transfixed stitch technique (TST) for haemorrhoidal prolapse, and thereby obtaining a significant technical and clinical improvement in terms of both outcomes (complete correction of rectal prolapse and haemorrhoidal prolapse) and discomfort and quality of life in the postoperative period. Moreover, in the present study the authors propose a subsequent innovation of the technique developed recently for the treatment of rectocele and haemorrhoidal disease using a new curved siliconate needle, thinner than the traditional lanceolate needles, with a longer, more rigid needle-thread junction in order to achieve less invasiveness and mucosal trauma, enabling the surgeon to perform sutures in a simple, easy manner. Ten consecutive patients with a clinical and instrumental diagnosis of rectocele--6 type II and 4 type III--were treated with TSTS and 20 patients with third (12 patients) and fourth degree (8 patients) haemorrhoidal disease were treated with TST. The surgical procedures were the same for all patients, although patients were divided into two groups. To the first group (A) were allocated patients treated with traditional stitches with a cylindrical, half circle needle, (Hr 25.9 mm). To the second group (B) were allocated, for the same objective, patients treated with the new siliconate needle, with an ultrafine tip, manufactured by Assut Europe S.p.A. The mean duration of the TST surgical procedures was 16 minutes using the new siliconate needle, whereas the mean duration using the traditional lanceolate needle was 17 minutes (p = ns). The surgical team judged the TST performed with the siliconate needle to be easier in 90% of cases in comparison to 70% of cases treated with the traditional lanceolate needle (p < 0,05). In patients treated with TSTS using the traditional lanceolate needle the mean duration of the surgical procedures was 20 minutes as against 18 minutes in the cases treated with the siliconate needle (p = ns). The surgical team judged the TSTS performed with the siliconate needle to be easier in all cases, while in two cases treated with the traditional lanceolate needle there were technical difficulties related to the use of the needle. The use of the ultrafine siliconate siliconate needle is more effective for the treatment of rectocele with TSTS and for haemorrhoidectomy with TST, particularly with a view to improving the surgical procedures and limiting the extent of mucosal damage related to suture oedema.
直肠膨出和痔脱垂是两种在所有情况下都需要对肛肠组织进行部分切除的病症，可能采用侵入性较小的手术方法。针对这些病症，作者最近改进了治疗方法，引入了用于直肠膨出的连续贯穿缝合法（STST）和用于痔脱垂的贯穿缝合法（TST），从而在治疗效果（直肠脱垂和痔脱垂的完全矫正）以及术后不适和生活质量方面都取得了显著的技术和临床改善。此外，在本研究中，作者提出了一项对最近开发的用于治疗直肠膨出和痔病的技术的后续创新，使用一种新型弯曲硅酸盐针，比传统的柳叶形针更细，针与线的连接处更长、更坚固，以实现更小的侵入性和黏膜创伤，使外科医生能够以简单、容易的方式进行缝合。连续10例经临床和器械诊断为直肠膨出的患者——6例II型和4例III型——接受了连续贯穿缝合法治疗，20例患有三度（12例）和四度（8例）痔病的患者接受了贯穿缝合法治疗。所有患者的手术步骤相同，尽管患者被分为两组。第一组（A）分配接受使用圆柱形半圆针（Hr 25.9 mm）的传统缝线治疗的患者。第二组（B）分配出于相同目的接受由Assut Europe S.p.A.制造的具有超细尖端的新型硅酸盐针治疗的患者。使用新型硅酸盐针进行贯穿缝合法手术的平均持续时间为16分钟，而使用传统柳叶形针的平均持续时间为17分钟（p = 无显著差异）。手术团队判断，与使用传统柳叶形针治疗的70%的病例相比，在90%的病例中使用硅酸盐针进行贯穿缝合法更容易（p < 0.05）。在使用传统柳叶形针进行连续贯穿缝合法治疗的患者中，手术平均持续时间为20分钟，而使用硅酸盐针治疗的病例为18分钟（p = 无显著差异）。手术团队判断在所有病例中使用硅酸盐针进行连续贯穿缝合法更容易，而在使用传统柳叶形针治疗的两例病例中存在与针的使用相关的技术困难。使用超细硅酸盐针对于用连续贯穿缝合法治疗直肠膨出和用贯穿缝合法进行痔切除术更有效，特别是为了改进手术方法并限制与缝合水肿相关的黏膜损伤程度。
