三种术式治疗重度痔的疗效比较

Comparison of clinical effects among three techniques in the treatment of severe hemorrhoids

目的:比较分析胶圈套扎术(RPH)联合外剥内扎术(M-M)、痔上黏膜环切钉合术(PPH)和M-M术治疗重度痔的临床效果。方法:收集2011年1月—2012年6月普外科收治的重度痔患者300例,随机分为RPH术联合M-M术治疗(R-M组)、PPH术治疗(PPH组)和传统M-M术治疗(M-M组)三组,每组100例。比较三种术式的疗效、住院时间、创面恢复时间、术后疼痛程度、术后并发症、手术对肛管动力学的影响、治疗费用、复发率和患者满意度。结果:R-M组、PPH组和M-M组患者手术过程均顺利,手术有效率组间差异无统计学意义(P>0.05);术后住院时间分别为(4.2±2.3)d、(3.8±2.4)d和(7.5±2.6)d,R-M组和PPH组低于M-M组(P<0.05);创面恢复时间分别为(20.6±7.5)d、(10.5±4.6)d、(27.6±8.3)d,PPH组低于R-M组和M-M组(P<0.05);术后疼痛3 h间段视觉疼痛评分PPH组均低于R-M组和M-M组(P<0.05);术后并发症分别为16.0%、28.0%、30.0%,R-M组低于PPH组和M-M组(P<0.05);术后肛管静息压力和收缩压力增加值M-M组大于R-M组和PPH组(P<0.05),直肠感觉阈值和排便阈值降低值PPH组大于R-M组和M-M组(P<0.05);治疗费用M-M组低于R-M组和PPH组(P<0.05);复发率R-M组低于PPH组和M-M组(P<0.05);患者满意度R-M组优于PPH组和M-M组(P<0.05)。结论:RPH术联合M-M术和PPH术都是治疗重度痔的有效方法,RPH术联合M-M术具有手术简单、创伤小和并发症少等特点;联合PPH术具有疼痛轻、恢复快和肛门功能影响小等特点。

Objective： To compare the clinical effects among three techiques [ruiyun procedure for hemorrhoids（RPH） combined with Milligan-Morgan（M-M） , procedure for prolapse and hemorrhoids（PPH） and M-M] in the treatment of severe hemorrhoids. Methods： Three hundred patients with severe hemorrhoids were enrolled from Jan. 2011 to June 2012 and randomly divided into R-M group, PPH group and M-M group with 100 each. The curative effect, hospital stay, wound recovery time, postoperative pain, postoperative complication, surgery impact on the kinetics of the anal canal, cost of treatment, relapse rate and the satisfaction were compared among the three groups. Results： All three groups had achieved successful operation. There were no significant differences in the effective rate of surgery among the three groups （P〉0.05）. The postoperative hospital stay of （4.2_± 2.3） d was found in the R-M group and （3.8± 2.4）d in the PPH group, both were lower than （7.5±2.6）d in the M-M group（P〈0.05）. The wound healing time of （10.5 ± 4.6）d was found in the PPH group which was shorter than that in the R-M group[（20.6 ± 7.5）d] and the M-M group[（27.6± 8.3）d]（P〈0.05）. The visual analogue pain score in a period of 3 hrs after operation in the PPH group was lower than that in the R-M group and the M-M group（P〈0.05）. Postoperative complication was 16.0% in the R-M group which was lower than that in the PPH group（28.0%）and M-M group（30.0%, P〈0.05）. The increased values of anal resting pressure and systolic pressure after operation in the M-M group were higher than those in the R-M group and the PPH group（P〈0.05）. The rectal sensorythreshold and the decreased value of defecation in PPH group were superior to those in the R-M group and the M-M group（P〈0.05）. The treatment cost of the M-M group was less than the R-M group and the PPH group（P〈0.05）. The relapse rate of the R-M group was lower than that of the PPH group and the M-M group（P〈0.05）. The satisfaction of the R-M group was higher than that of the PPH group and the M-M group（P〈0.05）. Conclusion： RPH combined with M-M or PPH is an effective way to treat severe hemorrhoid. RPH combined with M-M has been proved as simple, less invasive and less complications, while RPH combined with PPH has some advantages such as less pain, faster recovery and less impact on function of the anus.