吻合器痔上黏膜环切术加消痔灵注射配合外剥内扎术治疗重度混合痔189例

Procedure for prolapse and hemorrhoids combined with Xiaozhiling injection and Milligan-Morgan haemorrhoidectomy in the treatment of 189 cases of severe mixed hemorrhoids

目的:观察吻合器痔上黏膜环切术(PPH)加消痔灵注射配合外剥内扎术(本文简称"三明治"疗法)治疗重度混合痔的临床疗效。方法:将372例重度混合痔患者随机分成"三明治"治疗组189例及对照组(消痔灵注射、外剥内扎组)183例,对患者术后24h疼痛程度及术后排便疼痛指数、出血、伤口水肿、尿潴留、肛门坠胀、肛门控便能力、手术时间等进行比较,随访3年并记录痔复发或发生并发症情况。结果:2组患者在出血、肛门坠胀、肛门控便能力方面差异均无统计学意义(均P>0.05)。在术后排便疼痛、伤口水肿、尿潴留、手术时间方面"三明治"组优于对照组(P<0.05)。术后随访3年,"三明治"组术后吻合口出血3例,吻合口狭窄2例,复发2例;对照组术后出血7例、肛门狭窄3例、复发6例。结论:"三明治"疗法能够有效改善重度混合痔患者临床症状,治愈率高,复发率低,是重度混合痔安全有效的治疗方法。

Objective：To evaluate the efficacy of procedure for prolapse and hemorrhoids（PPH）combined with Xiaozhiling injection and Milligan-Morgan haemorrhoidectomy in treatment of severe mixed hemorrhoids.Methods：Three hundred and seventy-two patients with grade Ⅲ or Ⅳ mixed hemorrhoids admitted for surgical treatment.They were divided into two groups randomly：＂sandwich＂group（189 cases）and control group（183 cases）. ＂Sandwich＂group was treated with PPH（stapled hemorrhoidectomy procedure for prolapse and hemorrhoids）,Xiaozhiling injection method and Milligan-Morgan haemorrhoidectomy（MMH）,and control group was treated with standard MMH and Xiaozhiling injection method.Postoperative 24h-pain index,pain index in defecating,bleeding,anal discomfort feeling,wound edema,urinary retention,the ability of controlling feces and operating time were recorded.All the patients were followed for 3 years.Results：There were no significant differences between the two groups in bleeding,anal discomfort feeling,the ability of controlling feces（P〉0.05）.But the pain index in defecating, wound edema, urinary retention,and operating time was better in ＂sandwich＂group than control group（P〈0.05）.During 3 years of follow-up,there were 6 patients recurred and 7 patients suffered from postoperative bleeding,3 patients suffered from anal stenosis in control group,and there were 2patients recurred and 3 patients suffered from postoperative bleeding,2 patients suffered from anastomotic stricture in ＂sandwich＂group.Conclusion： ＂Sandwich＂therapy can effectively improve the clinical symptoms of patients with severe mixed hemorrhoids with high recovery rate and low recurrence rate.