痔上直肠黏膜环切术与Milligan-Morgan痔切除术对Ⅲ、Ⅳ度环状痔远期疗效比较

Comparison of long-term effects between procedure for prolapse and hemorrhoids and MilUgan- Morgan hemorrhoidectomy in the treatment of Ⅲ and IV degree of hemorrhoids

目的 比较痔上直肠黏膜环切术（PPH）与Milligan-Morgan痔切除术（MMH）对Ⅲ、Ⅳ度环状痔的远期疗效。方法回顾性分析2001年10月至2003年7月收治的Ⅲ、Ⅳ度环状内痔或以内痔为主的环状或近环状混合痔并获得随访5年以上的114例患者的临床资料，其中43例行PPH（PPH组），71例行MMH（MMH组）。结果PPH组术后晚期出血5例，MMH组无术后晚期出血病，例（P〈0．05）；PPH组术后痔脱垂复发9例，MMH组5例（P〈0．05）。PPH组直肠颈压力术前，术后6个月、1年、3年分别为（122．0±11．3）、（90．0±10．4）、（103．0±13．8）、（113．0±11．2）cmH2O（1cmH2O=0．098kPa）；MMH组分别为（126．0±13．5）、（91．0±12．4）、（78．0±9．8）、（81．0±7．5）cmH2O。PPH组术后6个月直肠颈压力较术前明显降低（P〈0．05），MMH组术后6个月、1年、3年直肠颈压力均较术前明显降低（P〈0．05）。结论PPH安全、近期疗效好，但晚期出血及肛门疼痛较多，远期复发率较高。

Objective To compare the long-term effects between procedure for prolapse and hemorrhoids （PPH） and Milligan-Morgan hemorrhoidectomy （MMH） in the treatment of Ⅲ and Ⅳ degree of hemorrhoids. Method The clinical data of 43 cases with Ⅲ and Ⅳ degree hemorrhoids received PPH （PPH group）and 71 cases received MMH （MMH group） were analyzed retrospectively from October 2001 to July 2003. Results Late bleeding in 5 cases of PPH group and no one of MMH group （P 〈0.05）. Hemorrhoidal recurrence prolapsed in 9 cases of PPH group and 5 cases of MMH group （P 〈 0.05）. The rectal neck pressure preoperative,after 6 months, 1 year and 3 years were （122.0 ± 11.3）, （90.0 ±10.4）, （103.0 ± 13.8） and （113.0 ±11.2） cm H2O （1 cm H2O =0.098 kPa） of PPH group,after 6 months was decreased obviously than preoperative （P 〈 0.05 ）, and they were （126.0 ± 13.5 ）, （91.0± 12.4）, （78.0 ± 9.8） and （81.0 ± 7.5） cm H2O of MMH group,after 6 months, 1 year and 3 years were decreased obviously than preoperative （P 〈 0.05）. Conclusion PPH is safety and effect at short time,but it brings more late bleeding and anal pain, and its rate of prospective hemorrhoidal recurrence is more higher than MMH.