痔上黏膜环切钉合术在混合痔切除术中的应用特点

Characteristics of PPH in Resection of Internal-external Hemorrhoids

目的探讨痔上黏膜环切钉合术(stapled hemorrhoidectomy,PPH)在混合痔切除术中应用的特点。方法采用前瞻性、分组对照的研究方法,符合痔切除标准的混合痔130例,按患者意愿分为痔切除组69例,单纯PPH组49例,PPH术后切除外痔和皮赘12例,各组年龄、性别、症状、体征构成等方面差异均无显著性。采用视觉模拟评分(VAS)观察术后～4周和术后首次排便、换药时疼痛程度,评估伤口3周愈合率和患者恢复工作时间,术后4周独立评估总体满意度,由手术医生观察、记录各指标,输机后统计。结果术后8 h内疼痛VAS单纯PPH组、痔切除组和PPH加痔切除组分别为5.43±2.15、5.75±2.25、5.67±2.23(F=0.313,P=0.732),第一次排便时的疼痛VAS中位数分别为3(1～8)、4(1～9)、5(2～9)(χ2=11.486,P=0.003),恢复工作时间中位数分别为5(3～20)、7(3～21)、7(3～12)d(χ2=6.339,P=0.042),3周愈合率分别为85.7%(42/49)、55.1%(38/69)、66.7%(8/12)(χ2=12.308,P=0.002),总体满意度中位数分别为100(70～100)、95(80～100)、95(85～100)(χ2=3.748,P=0.154)。结论 PPH可明显减轻痔切除术后疼痛、缩短恢复工作的时间、增加3周愈合率,即便在PPH同时切除外痔和皮赘也可达到这一效果。

Objective To observe the characteristics of stapled hemorrhoidectomy（PPH） in resection of internal-external hemorrhoids. Methods A prospective controlled trial was carried out in 130 patients with internal-external hemorrhoids,who matched with the criterion of hemorrhoidectomy.The patients were divided into hemorrhoidectomy group（69 cases）,simple PPH group（49 cases） and PPH ＋ resection of external hemorrhoids and skin tags group（12 cases） based on the patients＇ willingness.No significant difference was detected in the age,sex,symptoms and signs among the groups.VAS was employed to evaluate the level of the pain at the first defecation and dressing change within 4 weeks after the surgery.The rate of wound healing in 3 weeks,and the time for patients resume their daily activities was evaluated as well.The totally satisfaction of 4-week postoperation independent evaluation were recorded by surgeons. Results In the simple PPH,hemorrhoidectomy,and PPH ＋ resection of external hemorrhoids and skin tags groups,the VAS in 8 hours after the operation was 5.43±2.15,5.75±2.25,and 5.67±2.23（F=0.313,P=0.732） respectively,the median VAS for the pain at the first defecation was 3（1-8）,4（1-9）,and 5（2-9）（χ2=11.486,P=0.003）,median time for resuming daily activity was 5（3-20）,7（3-21）,and 7（3-12） d（χ2=6.339,P=0.042）,3-week wound healing rate was 85.7%（42/49）,55.1%（38/69）,and 66.7%（8/12）（χ2=12.308,P=0.002）,and the median total satisfaction was 100（70-100）,95（80-100）,and 95（85-100）（χ2=3.748,P=0.154）,respectively.Conclusions PPH can markedly reduce pain and the time back to work,and increase 3-week healing rate.The effect is not influenced by external hemorrhoids and tags excision after PPH.