吻合器经肛门直肠切除术与吻合器痔上黏膜环形切除术治疗Ⅳ度痔的对比研究

Stapled transanal rectal resection versus procedure for prolapse and hemorrhoids for the treatment of grade Ⅳ hemorrhoids

目的比较吻合器经肛门直肠切除术（stapled transanal rectal resection, STARR）与吻合器痔上黏膜环形切除术（procedure for prolapsed and hemorrhoids, PPH ）治疗Ⅳ度痔的临床疗效。方法选择2011年3月至2012年2月间北京大学人民医院胃肠外科同一手术治疗组施行STARR手术治疗的70例Ⅳ度痔患者（STARR组），并选取2010年3月至2011年2月间在北京大学人民医院接受PPH手术治疗的84例Ⅳ度痔患者（PPH组）作为对照组，回顾性分析、比较两组患者的手术安全性、短期效果和长期预后情况。结果两组术中出血量、住院天数、术后当天和术后第3天疼痛评分、术后第3天镇痛药物使用情况、术后并发症（如出血、感染）等指标差异均无统计学意义，均未发生直肠阴道瘘、直肠穿孔及术后死亡病例。STARR组手术时间、住院费用、术后当天镇痛药物使用率明显高于PPH组。STARR组3年疾病复发率较PPH组更低（0比5．9％）。结论STARR手术治疗Ⅳ度痔有助于降低远期复发。

Objective To evaluate stapled transanal rectal resection （STARR） in patients with grade IV hemorrhoids. Methods Between March 2010 and February 2012, 154 patients undergoing elective surgery for grade IV hemorrhoids by the same group of surgeons were included in the study. We compared patient data of two subdivided time periods, especially safety, effect, short-term outcomes and long-term outcomes. STARR was performed in 70 patients from March 2011 to February 2012. 84 patients underwent procedure for prolapse and hemorrhoids （PPH） from Mar 2010 to Feb 2011. Results The intraoperative blood, hospital stay, postoperative pain, and postoperative complications didn＇t show any statistical significance （ P 〉 0.05 ） . There were no cases of serious complications, such as rectovaginal fistula, rectal perforation, and postoperative deaths. However, the operating time, medical expenses and use of painkillers on operation-day in STARR group were increasing （ P 〈 0. 05 ）. Patients treated with the STARR procedure had lower recurrence rate of hemorrhoids at three years （0% vs 5.9% , P = 0. 048 ）. Conclusion STARR provides significantly lower recurrence rate of hemorrhoids than PPH in patients with grade IV hemorrhoids with equal safety, effect, and short-term outcomes.