PPH联合超声刀部分外痔切除治疗混合痔50例临床疗效分析

Clinical curative effect of PPH combined harmonic scalpel of partial external hemorrhoidectomy in treating mixed hemorrhoid:an analysis of 50 cases

目的评价吻合器痔上黏膜环切术（PPH）联合超声刀部分外痔切除术治疗混合痔的临床疗效。方法对PPH联合超声刀部分外痔切除治疗混合痔50例患者临床资料作回顾性分析。结果手术时间平均（20.2±4.1）min。术后患者住院时间平均（3±0.5）d。术后第1天疼痛评分平均（1.2±0.2）分;第2天便后疼痛评分平均（4.2±0.3）分;第7天便后疼痛评分平均（1.8±0.2）分;术后一周随访均未见痔核脱出及便血,无肛缘水肿。术后两周随访所有患者便后肛门疼痛均消失,无便血,无便后肛门痔核脱出。随访12~24个月,治愈率100%,均无便后肛门滴血或喷血及痔核脱出复发;无肛门狭窄;无排便失禁;无再次手术史。结论对于混合痔（内痔Ⅲ度、Ⅳ度）可采取PPH加超声刀部分外痔切除术,疗效满意,切实可行。

Objective The prevalence of symptomatic hemorrhoidal disease is a common disease that usually needs surgery for treatment.Although conservative treatment is often enough for early stages,late stage disease usually needs surgical treatment.The most common and effective approaches used for conventional surgical treatment are harmonic scalpel（HS）and procedure for prolapse and hemorrhoids（PPH）.We aimed to use the HS and PPH device for hemorrhoidectomy in GradeⅢ and GradeⅣ hemorrhoids and evaluate our results.Methods Enrolled participants into the study were 50 patients who were operated for symptomatic Grade Ⅲ and Grade Ⅳ hemorrhoids.The present review focused on operating time,postoperative pain,length of hospital stay,and postoperative complications.Results The mean ages of patients were 46±9.1（22~77）years.The mean operating time was 20.2±4.1minutes.The average postoperative stay was 3±0.5days.The VRS pain scores on postoperative Day 1,Day 2,Day 7,and Day 14 were 1.2±0.2,4.2±0.3,1.8±0.2,and 0,respectively.During the 12 to 24months＇ follow-up,there was no recurrence in terms of bleeding,prolapse,anal abscess,anal stenosis and anal incontinence.Conclusion Surgical treatment of HS and PPH for hemorrhoidectomy in GradeⅢ and GradeⅣ hemorrhoids is effective,which is worthy to be generalized.