自动痔疮套扎术在痔合并肛瘘治疗中的应用

Application of ruiyun procedure for hemorrhoids in the combination of hemorrhoid and anal fistula

目的探讨自动痔疮套扎术（RPH）治疗痔合并肛瘘的临床效果。方法选取2012年9月~2013年3月在湖南中医药大学第一附属医院肛肠科住院的121例内痔合并低位单纯性肛瘘患者按照随机数字表法分成两组,治疗组61例患者采用RPH＋瘘管切除术治疗;对照组60例患者采用内痔缝扎术＋瘘管切除术治疗;观察周期为35 d,随访3年。比较两组患者治疗效果、术后24 h疼痛积分、术后首次排便疼痛积分及持续时间、手术时间、术后恢复时间、术后并发症及术后3年痔复发情况。结果两组疗效差异无统计学意义（P〉0.05）;治疗组患者术后24 h疼痛积分、首次排便疼痛积分及持续时间、手术时间及术后恢复时间与对照组比较显著降低或缩短（P〈0.05或P〈0.01）;治疗组术后并发症发生率低于对照组（P〈0.05）;两组术后3年痔复发情况比较差异无统计学意义（P〉0.05）。结论 RPH在痔合并肛瘘中应用的近、远期疗效肯定,值得临床推广。

Objective To discuss the clinical effect of ruiyun procedure for hemorrhoids（RPH） in the treatment of hemorrhoid combined with anal fistula. Methods 121 patients with internal hemorrhoid complicated with low simple anal fistula in Department of Anorectal, the First Affiliated Hospital of Hu＇nan University of Chinese Medicine from September 2012 to March 2013 were divided into two groups, according to random number table. 61 patients in the treatment group were adopted RPH plus low anal fistula resection and 60 patients in the control group were adopted internal hemorrhoid transfixion plus low anal fistula resection. The observation cycle was 35 days and followed up for 3 years.The clinical effect, pain scores of 24 hours after surgery, pain scores and duration of the first defecation after surgery,surgical time, postoperative recovery time, postoperative complications and recurrence of hemorrhoid 3 years after operation were compared between the two groups. Results The difference in clinical effect between the two groups was not statistically significant（P〈0.05）. Compared with the control group, the pain scores of 24 hours after surgery, pain scores and duration of the first defecation after surgery, surgical time and postoperative recovery time of the treatment group had reduced significantly（P〈0.05 or P〈0.01）. The incidence of postoperative complications in the treatment group was lower than the control group（P〈0.05）. There was no significant difference in the recurrence of hemorrhoid3 years after operation between the two groups（P〈0.05）. Conclusion The short-term and long-term effect of RPH in the treatment of hemorrhoid combined with anal fistula is positive and worthy of clinical application.