摘要
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.
出处
《中华胃肠外科杂志》
CAS
2008年第6期525-528,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
混合痔
吻合器痔上黏膜环切钉合术
外剥内扎术
Mixed hemorrhoid
Procedure for prolapse and hemorrhoids
Milligan-Morgan operation