选择性痔上黏膜切除术联合外痔切除治疗重度混合痔的临床研究

Clinical study of tissue-selecting therapy stapler combined with extemal hemorrhoidectomy in treating severe mixed hemorrhoids

目的探讨选择性痔上黏膜切除术（TST）联合外痔切除术治疗重度混合痔的临床效果。方法选取2014年7月-2015年8月我院收治的156例混合痔患者为研究对象,将其分为观察组和对照组,各78例。观察组患者应用TST联合外痔切除术治疗,对照组应用吻合器痔上黏膜环切术（PPH）治疗。比较两组患者的治疗效果及并发症发生率。结果观察组治愈72例,治愈率为92.31%,显著高于对照组的80.77%,差异有统计学意义（P〈0.05）;观察组的手术时间短于对照组、术中出血量少于对照组、视觉模拟疼痛评分明显低于对照组,差异有统计学意义（P〈0.05）。观察组肛门坠胀、肛管狭窄、异常出血、肛缘水肿四种不同的并发症的总发生率为15.38%,远低于对照组的46.15%,差异有统计学意义（P〈0.05）。结论 TST联合外痔切除术较PPH治疗混合痔的临床疗效理想,并发症发生率低,值得临床推广。

Objective To observe the clinical effects of tissue-selecting therapy stapler（TST） combined with extemal hemorrhoidectomy in treating severe mixed hemorrhoids. Methods 156 mixed hemorrhoids patients from July 2014 to August 2015 of our hospital were selected as study objects.The patients were divided into observation group and control group.Each group was 78 cases.Patients in observation group were used TST combined with extemal hemorrhoidectomy,and patients in control group were used procedure for prolapseand hemorrhoids（PPH）.The treatment effects and incidence rate of complications in two groups were compared. Results The cure number of observation group was 72 and the cure rate was 92.31%,obviously higher than that was 80.77% in control group with statistical difference（P〈0.05）.The operation time of observation group was shorter than that of control group,bleeding volume during operation was less than that of control group and VAS score of observation group were obvious lower than that of control group,with statistical difference（P〈0.05）.The four complications incidence liked anal pendant expansion,anorectal stenosis,abnormal bleeding and edema of anal edge,the total incidence rate of complications in observation group was 15.38%,far lower than 46.15% in control group,with statistical difference（P〈0.05）. Conclusion TST combined with extemal hemorrhoidectomy has more ideal clinical effects than PPH treatment,which can obviously decrease complications and is worth to popularize in clinic.