经肛门痔上黏膜环切术偏心性切除吻合在直肠良性肿瘤伴抑郁的疗效观察

Transanal resection and anastomosis of PPH eccentric research and application value in the treatment of rectal benign tumors

目的探讨经肛门痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)偏心性切除吻合治疗直肠良性肿瘤伴抑郁的效果。方法选取2012年6月到2014年6月住院接受治疗的104例良性肿瘤伴抑郁患者为研究对象,随机数表法分为对照组(50例)与观察组(54例),对照组行传统肛门手术治疗,观察组行经肛门PPH偏心性切除吻合术,比较两组患者的治疗有效率及术后并发症情况。结果治疗后3个月,两组患者病情均好转,观察组的总有效率为96.30%,显著高于对照组的84.0%(P<0.05);观察组患者的术后恢复时间(平均为6.32天)和术后疗效评分(平均为9.36分)均显著优于对照组患者(术后恢复时间平均为10.87天、术后疗效美分平均为7.13分)(P<0.05)。两组患者治疗前的抑郁自评量表(SDS)及焦虑自评量表(SAS)评分相似;其治疗后的SDS及SAS评分明显高于治疗前,且治疗后观察组患者SDS及SAS评分明显低于对照组(P<0.05)。结论对于直肠良性肿瘤伴抑郁患者,肛门PPH偏心性切除吻合治疗在其恢复速度、术后并发症及抑郁改善等方面明显优于传统的手术治疗,可能有重要的临床推广价值。

Objective To investigate the therapeutic effect of the transanal resection and anastomosis of procedure for prolapse and hemorrhoids （PPH） eccentric on rectal benign tumor. Methods One hundred and four patients with rectal benign tumor, complicated with depression, were sampled from June 2012 to June 2014 when treated in the hospital. These patients were randomly divided into control group （ n = 50 ）, treated with traditional anal operation, and observation group （n = 54）, treated with anal PPH eccentric resection and anastomosis. The effective response rates of the treatment and the complications after the treatment were compared between the two groups. Results The two groups were similar clinically before the treatment. After the treatment for 3 months, the two groups were improved; the total effective response rate of the observation group was 96.30 %, significantly higher than that of the control group （ 84 % ）（ P〈0.05 ）, and the average recovery time of the observation group patients after the treatment （ 6.32 days ） and the scores of postoperative effect （ 9.36 ） were obviously superior to that of the control group patients （ 10.87 days and 7.13, respectively ）（ P 〈 0.05 ） . As for emotional aspect, the two groups improved in depresion and aniety, and the observation group demonstrated more improvement than did the control group, in according to their scores in the Self-rating depression scale （ SDS ） and the Self-Rating Anxiety Scale （ SAS ） . Conclusion This study suggests that transanal resection and anastomosis of PPH eccentric has better therapeutic effects on treatment of patients with rectal benign tumor when compared with the traditional anal operation, and may be worthy of generalized application in clinical practice.