PPH术与改良分段结扎术治疗环状混合痔的疗效分析

PPH and improved segmented ligation in the treatment of circumferential mixed hemorrhoids

目的探讨PPH与改良分段结扎术治疗Ⅲ、Ⅳ度痔合并肛裂、肛乳头肥大、肛周皮赘、肛门狭窄的临床疗效。方法将108例具有肛门合并症的Ⅲ、Ⅳ度痔患者在知情同意后,随机分为PPH组54例,改良分段结扎组54例,比较两组术后疼痛、肛门水肿、手术费用、愈合时间、手术满意度、术后1个月、6个月肛门镜检结果,术后6个月、12个月随访结果。结果(1)术后8h视觉模拟疼痛(VAS)评分PPH组3.3(2～5),改良分段结扎组5.6(4～7),P<0.05,术后24h肛门静息时VAS评分,两组无差异,P>0.05,无统计学意义,术后24h排便疼痛(VAS)评分PPH组优于改良分段结扎组。(2)肛门水肿PPH组0例,改良分段结扎组4例,P<0.05。(3)愈合时间PPH组10～18d,改良分段结扎组15～25d,P<0.05。(4)手术费用PPH组(6120±238)元,改良分段结扎组(2830±180)元,P<0.05。(5)1个月、6个月两次肛镜检查PPH组在吻合口近或远侧有隆起增生的肛垫组织6例,改良分段结扎组1例,两组均无症状与不适。(6)满意度调查PPH组95%,改良分段结扎组92%,P>0.05。结论PPH术与改良分段结扎术两者均为有效治疗有肛门合并症的环状混合痔。术后疼痛、肛门水肿、愈合时间3个方面PPH术优于改良分段结扎术,手术费用少、远期并发症少、肛门外观平整是改良分段结扎术的优点。根据随访结果,PPH术后有明显改善便秘的症状,因此,对于内痔为主伴有便秘和肥胖的患者PPH术较好;外痔多于内痔、有陈旧性肛裂、肛门狭窄、肛乳头肥大等良性合并症的患者,改良分段结扎术较好。

Objective To investigate the clinical effects of PPH and improved segmented ligation in the treatment of Ⅲ-Ⅳ degree circumferential mixed hemorrhoids complicated with anal fissure, hypertrophy of anal papilla and anal stenosis. Methods A total of 108 patients with Ⅲ-Ⅳ degree circumferential mixed hemorrhoids complicated with other anal diseases were randomly divided into PPH group （54 cases） and improved segmented ligation group （54 cases）. Results （1） Eight hours after operation, visual analogue pain score （VAS）inPPH group was 3.3 （2-5）, 5.6 （4-7） in ligation group （P 〈0.05）. Twenty-four hours after operation, defecation pain score in improved PPH was lower than that in ligation group. （2） Anal edema occurred in 4 cases in ligation group, and no case in PPH group （ P 〈0.05）. （3） The healing time was 10-18 days in PPH group and 15-25 days in ligation group （ P 〈0.05）. （4） The costs of operation was 6120＋-238yuaninPPH group and 2830＋-180 yuan in ligation group （P〈0.05）. （5） One month and six months after operation, anoscope examination revealed 6 cases with hyperplastic anal cushions near anastomosis in PPH group and 1 case in ligation group. （7） The satisfaction rate was 95% and 92%, respectively, in PPH group and ligation group （ P 〉0.05）. Conclusion PPH and improved segmented ligation are all effective for circumferential mixed hemorrhoids complicated with other anal diseases. PPH has less postoperative pain, anus edema and shorter healing time. Improved segmented ligation is with less costs of operation and fewer long-term complications. Improved segmented ligation is suitable for patients complicated with chronic anal fissure, hypertrophy of anal papilla and anal stenosis.