直针手缝痔固定术与直肠黏膜环切钉合术治疗Ⅲ、Ⅳ度痔的临床疗效分析

A comparative clinical study on procedure for prolapse and heamorroids and straight-needle hand-

目的比较直针手缝痔固定术（straight—needlehand-sewingheamorroidpexy，HHP）和直肠黏膜环切术（procedureforprolapseandheamorroids，PPH）治疗Ⅲ～Ⅳ度痔的近期及远期临床疗效。方法按完全随机对照分组原则将800例Ⅲ～Ⅳ度痔分为HHP术组（385例）和PPH术组（415例），观察并比较两组患者术后近期及远期临床效果。数据采用t检验及X2检验。结果手术时间HHP组（35．1±6．2）min，PPH组（20．7±5．1）min；住院时间HHP组（4．8±2．2）d，PPH组（5．5±2．1）d，两组比较差异无统计学意义。术后疼痛采用视觉模拟评分（visualanaloguescale，VAS）（≥5分为重度疼痛），t〉5分者HHP组45例（占12．1％）；PPH组128例（占31．8％）；术后平均恢复工作生活时间，HHP组（5．2±2．3）d，PPH组（10．2±2．4）d；术后并发症（包括出血、痔核突出及吻合口狭窄等需要再次手术者），HHP组5例（0．01％），PPH组17例（0．51％）；住院总费用HHP组平均为3520．2元，PPH组平均为8925．2元；患者满意度，HHP组93．9％，PPH组83．1％。统计学分析在近期疗效各指标中，HHP组均明显优于PPH组。术后随访2～5年，HHP组随访278例，PPH组随访292例。术后需要再次手术者中，便血HHP组17例（6．1％），PPH组44例（15．1％）；痔核脱出HHP组12例（4．3％），PPH组52例（17．8％），两组比较差异亦有统计学意义（χ^2：4．25，P〈0．05）。在排便功能方面（如排便感觉异常、便秘、便急或大便失禁等）两组无明显差异。结论与PPH术相比，HHP术具有安全、痛苦小、费用低、并发症少及患者满意度高等优点，值得推广。

Objective To compare the short-term and long-term results of hand-sewing heamorroidpexy（HHP） and procedure for prolapse and beamorroids（PPH） in the treatment of grade Ill and IVheamorrhoids. Methods Eight hundred patients were randomly divided into two groups receiving PPH （n =415） and HHP（ n = 385） respectively. The operative result including postoperative pain, prolapse, total expense, time to return normal work, percentage of satisfaction and other complications were compared between the two groups. Result The time of resuming normal work in HHP group was （5.2 ± 2.3 ） d,in PPH group was （ 10. 2±2. 4） d, P =0. 038. Postoperative visual analogue scale≥5 was found in 45 cases （ 12. 1% ） in HHP group, and in 128 cases （31.8 % ） in PPH group, P =0. 018. HHP group was superior to PPH group in patients＇ satisfaetion, inhospital cost, complications, and recurrence, all P 〈 0. 05. Patients were followed up for more than 2 years, long term complication of bleeding, prolapse and anastomtie structure developed less frequently in HHP group than in PPH group （ X2 = 4. 25, P 〈 0.05 ）. Conclusions HHP is a safe and effective treatment for heamorroids （gradeⅢ- 1V ） with the advantages of less postoperative pain, quicker recovery, lower expenses, shorter hospital stay and higher satisfactory rate.