内痔自动套扎术和痔上黏膜环切术治疗老年内痔的对比研究

Comparative Study Between Automatic Ligation of Hemorrhoids and Procedure for Prolapsed Hemorrhoids on Elderly Patients with Hemorrhoids

目的观察内痔自动套扎术（ALH）及吻合器痔上黏膜环切术（PPH）治疗老年内痔的疗效和安全性。方法选取2012年1月至2014年12月期间济宁市第一人民医院收治的老年内痔患者180例,根据患者采用的手术方式分为ALH组和PPH组各90例,分别接受ALH和PPH治疗,观察2组患者术后疼痛、尿潴留、水肿、出血、感染、肛门坠胀及肛门狭窄的发生情况;分别从手术时间、术中出血、术后出血、术后疼痛、愈合时间、住院费用及术后并发症方面评价两种手术方式。结果 ALH组术后第1～3天的视觉模拟评分（VAS）均低于PPH组,差异均有统计学意义（P〈0.05）;ALH组止痛剂使用次数少于PPH组（P〈0.01）;ALH组术中出血量和愈合时间均明显少于或短于PPH组（P〈0.01）;ALH组术后尿潴留的发生率为2.22%（2/90）,明显低于PPH组的27.78%（25/90）,差异有统计学意义（χ^2=23.050,P=0.000）;ALH组术后肛缘水肿的发生率为5.56%（5/90）,明显低于PPH组的15.56%（14/90）,差异有统计学意义（χ^2=4.766,P=0.029）;ALH组术后未见明显出血（0/90）,PPH组术后出血的发生率为7.78%（7/90）,2组的差异有统计学意义（Fisher＇s精确概率检验,P=0.007）;ALH组的有效率为98.89%（89/90）,PPH组的有效率为97.78%（88/90）;2组的差异无统计学意义（χ^2=0.339,P=0.560）。结论 ALH与PPH治疗老年内痔的疗效无显著性差异,但ALH治疗老年内痔具有疼痛轻、恢复快、并发症少的优点,值得推广应用。

Objective To compare the efficacy and safety of automatic ligation of hemorrhoids（ALH） and procedure for prolapsed hemorrhoids（PPH） in the treatment of elderly patients with hemorrhoids. Methods One hundred and eighty elderly patients with hemorrhoids who were admitted into the First People＇s Hospital of Jining City from January 2012 to December 2014 were enrolled. According to the operative mode, the patients were divided into ALH group and PPH group, with 90 cases in each group, received ALH and PPH treatment respectively. The postoperative pain, urinary retention, edema, bleeding, infection, anal swelling and anal stenosis were observed in the two groups, and two methods of operation were evaluated in terms of operation time, intraoperative bleeding, postoperative bleeding, postoperative pain, healing time, hospitalization expenses and postoperative complications. Results The VAS scores of the ALH group in the day 1-3 after operation were lower than that of the PPH group, the difference was statistically significant（P〈0.05）; the frequency of the use of analgesics in ALH group was less than that in PPH group（P〈0.01）; the amount of blood loss and the healing time of the ALH group were significantly less or shoter than those of the PPH group（P〈0.01）; the incidence of postoperative urinary retention in the ALH group was 2.22%（2/90）, which was significantly lower than that of the PPH group, 27.78%（25/90）, the difference was statistically significant（χ2=23.050, P=0.000）; the incidence of perianal edema after operation in the ALH group was 5.56%（5/90）, which was significantly lower than that of PPH group of 15.56%（14/90）, the difference was statistically significant（χ2=4.766, P=0.029）. There was no obvious postoperative bleeding in the ALH group（0/90）, while the incidence of postoperative bleeding in the PPH group was 7.78%（7/90）, and the difference between the two groups was statistically significant（Fisher＇s exact test, P=0.007）. The efficiency of ALH group was 98.89%（89/90） and the PPH group was 97.78%（88/90）, the difference between the two groups was not statistically significant（χ2=0.339, P=0.560）. Conclusions There is no significant difference between ALH and PPH in the treatment of elderly patients with hemorrhoids, but ALH has the advantages of less pain, quicker recovery and fewer complications, it is worthy of popularization and application.