不同术式治疗直肠内脱垂伴混合痔患者的疗效及并发症原因分析

Effects of different surgical methods for treating internal rectal prolapse complicated with mixed hemorrhoids and causative analysis of complications

目的比较直肠内脱垂伴混合痔患者采用不同术式治疗的疗效并对术后并发症原因进行分析。方法选择2013年2月至2015年9月收治的89例直肠内脱垂伴混合痔患者作为研究对象,按随机数字表法分为A组(n=45)与B组(n=44)。A组采取单荷包缝合术,B组采取双荷包缝合术,比较两组术中情况(手术时间、出血量、切除黏膜宽度)、治疗有效率与术后并发症发生率。结果 A组手术时间、出血量、切除黏膜宽度均小于B组,差异有统计学意义(P均<0.01)。A组治疗有效率为93.3%(42/45),明显高于B组的77.3%(34/44),差异有统计学意义(P<0.05)。A组急便感、假性憩室发生率均低于B组,黏膜复位不佳发生率则高于B组,差异有统计学意义(P均<0.05)。结论直肠内脱垂伴混合痔的手术方式较多,其中以单荷包缝合术的效果较佳,不仅手术时间短,且出血量少,还可有效减少术后急便感、假性憩室等并发症的发生率,快速、疼痛轻、安全、有效。

Objective To compare the effects of different surgical methods for treating internal rectal prolapse complicated with mixed hemorrhoids and analyze the causes of postoperative complications. Methods A total of 89 patients with internal rectal prolapse and mixed hemorrhoids treated in Anorectal Department of Yanting People’ s Hospital from February 2013 to September 2015 were selected as research objects and were divided into group A（ n = 45） and group B（ n = 44）by random number table. The single purse-string suture was performed in group A,and double purse-string suture was performed in group B. The intraoperative information（ operation time,bleeding volume,resected mucosal width）,the effective rate of treatment and the incidence of postoperative complications were compared between two groups. Results Compared with group B,the operation time,bleeding volume and resected mucosal width in group A significantly decreased（ all P 〈0. 05）. The effective rate in group A was significantly higher than that in group B [93. 3%（ 42 /45） vs 77. 3%（ 34 /44）,P 〈 0. 05]. The incidences of acute defecating feeling and gingival pocket in group A were significantly lower than those in group B,while the incidence of poor mucosal restoration in group A was significantly higher than that in group B（ all P 〈0. 05）. Conclusions Though there are many surgical methods for endorectal prolapse complicated with mixed hemorrhoids,the single purse string suture is more effective because of the advantages of shorter operation time,smaller bleeding amount,less incidences of complications such as postoperative acute defecating feeling,gingival pocket as well as fast,less pain,safety,better efficacy.