吻合器痔上黏膜环形切除术与外剥内扎术的对比研究

Procedure for prolapse and hemorrhoids versus Milligan-Morgan haemorrhoidectomy: a randomised controlled trial

目的探讨吻合器痔上黏膜环形切除术(PPH)治疗重度脱垂性混合痔的临床效果。方法将354例Ⅲ～Ⅳ度混合痔患者随机分组进行PPH(治疗组)和外剥内扎术(对照组)治疗,每组177例,对比观察两组手术时间、创口愈合时间、住院时间、术后疼痛指数、肛门功能测定及术后并发症发生率等指标。结果手术后两组患者原有症状均得到了有效控制。手术时间、创面愈合时间和住院时间治疗组与对照组分别为(13.5±3.2)与(26.6±6.3)min、(7.0±2.5)与(24.0±8.0)d和(3.0±1.0)与(10.5±3.5)d,两组比较,(P<0.01)。术后疼痛指数治疗组(2.3±1.2)明显低于对照组(7.7±1.1)(P<0.01);治疗组肛门功能的恢复优于对照组,肛管压力测定治疗组手术前后无变化;而对照组术后明显降低(P<0.01)。术后并发症的发生率两组比较,除肛缘外残留皮赘发生率治疗组(7.9%)较对照组(4.5%)增多(P<0.05)外,其余差异均无显著性意义(P>0.05)。结论PPH在治疗Ⅲ～Ⅳ度混合痔方面明显优于传统手术,但长期疗效尚需追踪随访。

Objective To evaluate the efficacy of procedure for prolapse and hemorrhoids(PPH) for the treatment of Ⅲ～Ⅳdegree hemorrhoids. Method Three hundred and fifty four patients were randomly divided into two groups and received PPH(n=177) and Milligan Morgan haemorrhoidectomy(n=177) respectively. Operating time,wound healing time,hospital stay,pain scores,anal function and postoperative complications were compared. Results The operating and wound healing times and hospital stay were(13.5±3.2)min,(7.0±2.5)d and (3.0±1.0)d respectively in PPH group,all significantly shorter than (26.6±6.3)min,(24.0±8.0)d and (10.5±3.5)d in Milligan Morgan group (P< 0.01). Postoperative pain scores and anal function restoration were better in PPH group than those in Milligan Morgan group(P< 0.01). There was no difference in postoperative morbidity rates between two groups except a higher morbidity rate(7.9%) of rudimental acrochordons in PPH group. Conclusions As compared with the traditional Milligan Morgan operation,PPH is a safe and effective procedure for Ⅲand Ⅳdegree hemorrhoids. However,long term outcomes require further study.