吻合器痔上黏膜环切钉合术加外痔切除术治疗混合痔的疗效分析

Efficacy of the procedure for prolapse and hemorrhoids combined with external hemorrhoids excision in the treatment of Ⅲ or IVmixed hemorrhoids

目的研究吻合器痔上黏膜环切钉合术（PPH）加外痔切除术治疗Ⅲ、Ⅳ度混合痔的临床疗效。方法将112例混合痔患者随机分成PPH1组34例、PPH2组36例、剥扎组42例，PPH1组采用单纯PPH术，PPH2组采用PPH加外痔切除术，剥扎组采用外剥内扎术治疗。观察和比较3组患者术后24h疼痛程度及术后排便疼痛指数、出血、伤口水肿、尿潴留、肛门坠胀、肛门控便能力、手术时间、住院时间和费用等指标；肛肠测压仪检测手术前后3组患者肛管动力学变化指标；随访0．5。1年并记录痔复发或发生血栓外痔情况。结果PPHl组术后24h疼痛指数低于另外2组（P〈0．05）：3组患者在出血、肛门坠胀、肛门控便能力方面差异无统计学意义（P〉0．05）。在术后排便疼痛、伤口水肿、手术时间、住院时间方面，PPHl组和PPH2组优于剥扎组（P〈0．05）：在术后尿潴留、费用方面剥扎组处于优势（P〈0．05）。手术前后剥扎组肛管静息压变化值小于另外2组（P〈0．05），手术前后3组患者直肠感觉阈和直肠耐受量变化值差异无统计学意义（P〉0．05）。随访半年至1年，PPH1组无复发患者，有3例发生血栓外痔；PPH2组无复发患者；剥扎组复发2例，发生血栓外痔1例。结论PPH加外痔切除术是治疗混合痔的安全有效术式，适合外痔严重的混合痔。

Objective To investigate the efficacy of the procedure for prolapse and hemorrhoids （PPH） combined with external hemorrhoids excision in the treatment of Ⅲ or Ⅳ mixed hemorrhoids. Methods One hundred and twelve patients with Ⅲ or IV mixed hemorrhoids admitted for surgical treatment were randomly divided into three groups： PPH 1 group （34 cases）, PPH2 group （36 cases）, and Milligan-Morgan group （42 eases）. PPH1 group received the standard PPH operation, PPH2 received PPH and external hemorrhoids excision, and Milligan-Morgan group received MiUigan- Morgan hemorrhoidectomy. Postoperative 24 h-pain index, pain index when defecating, bleeding, anal discomfort feeling , wound edema, the ability of controlling feces, operating time, hospitalization time and charges were recorded. The change of anal dynamics was detected by anoreetal manometry. All the patients were followed-up for 0.5-1 year. Results There were no significant differences among the three groups in bleeding, anal discomfort feeling, the ability of controlling feces（P〉0.05）. The postoperative 24 h-pain index of PPH1 group was lower than those of the other two groups （P〈0.05）. PPH1 group and PPH2 group were better than Milligan-Morgan group in pain index when defecating, wound edema, operating time, and hospitalization time （P〈0.05）. Milligan-Morgan group was better than the other two groups in postoperative urinary retention and hospital charges（P〈0.05）. The change of anal duct pressure of Milligan-Morgan group was less than those of the other two groups（P〈0.05）. Within 0.5-1.0 year follow-up, 3 patients got thrombosed external hemorrhoid in PPH1 group, 2 patients recurred and 1 patient got thrombosed external hemorrhoid in MiUigan-Morgan group, no recurred patients in PPH2 group. Conclusion PPH combined with external hemorrhoid excision is a safe and effective treatment for mixed hemorrhoids, which is suitable for mixed hemorrhoids with severe external hemorrhoids.