PPH合并肛瘘切除缝合术的手术顺序评价

The Order of Evaluation of PPH Combined with Operation of Anal Fistula Resection and Suture Operation

目的:对PPH合并肛瘘切除缝合术的手术顺序做出研究和评价,为临床提供必要依据。方法:研究对象选取2013年1月-2014年1月笔者所在医院收治的100例环形混合痔合并低位肛瘘患者,在患者知情同意的情况下,按照入院单双号进行随机分组,A组50例患者先行PPH手术再行肛瘘切除缝合术,B组50例患者则先行肛瘘切除缝合术再行PPH手术,对两组患者的手术时间、术后并发症及术后疼痛程度进行统计对比。结果:A组患者的手术时间为(20.6±4.5)min,显著低于B组患者的(24.1±7.2)min,差异有统计学意义(P<0.05);A组患者中,吻合口出血1例,肛瘘缝合口出血1例,肛瘘缝合口感染1例,并发症发生率6.0%,B组患者中,吻合口出血1例,肛瘘缝合口出血9例,肛瘘缝合口感染8例,术后肛瘘复发2例,并发症发生率40.0%,A组显著低于B组,差异有统计学意义(P<0.05);A组患者VAS评分为(3.8±1.1)分,显著低于B组的(6.2±1.2)分,A组疼痛时间(35.6±6.9)h,低于B组的(46.7±10.4)h,差异均有统计学意义(P<0.05)。结论:环形混合痔合并低位肛瘘患者在手术治疗顺序选择上,建议先行PPH手术治疗,再行肛瘘切除缝合术,能够有效减少手术时间,降低并发症的发生,控制患者术后疼痛程度及疼痛时间,值得在临床上推广和应用。

Objective： To study and evaluate the operation sequence of PPH with anal fistula resection and suture operation, to provide the necessary basis for clinical.Method： From Jan 2013 to Jan 2014 in our hospital 100 cases of annular mixed hemorrhoids complicated with low anal fistula patients, under the informed consent of patients, were randomly divided into two groups according to the odd and even number of admission, 50 cases in group A received PPH operation again for anal fistula resection and suture operation, 50 patients in group B with anal fistula resection and suture operation was first PPH operation again, statistical comparison of operation time, two groups of patients with postoperative complications and postoperative pain degree.Result： The operation time of group A was （20.6 ＋ 4.5）min, was significantly lower than （24.1 ~ 7.2）rain of group B, there was significant difference（P〈0.05）.In the group A, 1 case of anastomotic bleeding, 1 case of anal fistula anastomotic bleeding, 1 case of anal fistula sewing suture bleeding and infection, the complication rate was 6.0%.In the group B, 1 case of anastomotic bleeding, 9 cases of anal fistula anastomotic bleeding, 8 cases of anal fistula bleeding in suture, 2 cases of infection of postoperative recurrence of anal fistula, the complication rate was 40.0%, group A was lower than of the group B, there was significant difference（P〈0.05）.VAS score of the group A was （3.8 ± 1.1）, was significantly lower than （6.2 ± 1.2） of group B, the time of pain of group A was （35.6 ± 6.9）h, was shorter than （46.7 ± 10.4）h of group B, the differences were statistically significant（P〈0.05）. Conclusion： Annular mixed hemorrhoids complicated with low anal fistula patients in the operation treatment of order selection, recommendations to PPH operation in the treatment of anal fistula resection and suture operation, can effectively reduce the operation time and the incidence of complications, the degree of pain and the duration of pain control of patients after surgery, is worthy of clinical popularization and application.