痔上黏膜环切术与选择性痔上黏膜切除术治疗Ⅲ度混合痔疗效及安全性临床对比分析

Clinical efficacyand safety of Ⅲ degreemixed hemorrhoids with PPH and TST:A prospective randomized controlled study

目的对比和评价痔上黏膜环切术(PPH)和选择性痔上黏膜切除术(TST)治疗Ⅲ度混合痔的临床疗效及安全性。方法将2012年6月至2014年3月间就诊于新疆医科大学第一附属医院肛肠科120例Ⅲ度混合痔病人按随机数字表法分为痔上黏膜环切术组(PPH组)和选择性痔上黏膜切除术组(TST组),每组60例,前瞻性对比观察两组病人的手术时间、术中牵拉不适感、术后肛门疼痛、术后出血、术后肛周水肿、术后肛门狭窄和术后住院时间等指标,并于术后6个月对两组病人进行肛门直肠测压以客观评估肛门生理功能的恢复情况。结果与TST组相比,PPH组术中牵拉及不适感明显,术后疼痛轻,术后肛周水肿轻,两组差异有统计学意义(P<0.05);两组手术时间、术后出血、术后住院时间、术后肛门狭窄差异均无统计学意义(P>0.05)。术后6个月肛门直肠测压示:PPH对肛门括约肌的损伤更小。结论在Ⅲ度混合痔的治疗上,痔上黏膜环切术效果优于选择性痔上黏膜切除术,更能保护肛门的生理功能,但要考虑到术中牵拉不适感的问题。

Objective To compare and evaluate the clinical efficacy and safety of procedure for prolapse and hemorrhoids （PPH） and tissue-selecting therapy stapler （TST）in treating Ⅲ degree mixed hemorrhoids. Methods A total of 120 patients with m degree mixed hemorrhoids admitted in the Department of Anorectal, the First Affiliated Hospital of Xinjiang Medical University from June 2012 to March 2014 were divided into PPH group and TST group according to random number table method, and each group contained 60 patients.The following indexes in each group were compared and observed prospectively： operation duration time, intraoperative pull discomfort, postoperative anal pain, postoperative bleeding, postoperative anal edema, postoperative anal stenosis and postoperative hospitalization time. The anal function recovery situation with anorectal manometry in each group after the surgery finished 6 months later was evaluated objectively.Results Compared with the TST group,patients accept the PPH surgery had the characteristics of obvious intraoperative pull and discomfort, lighter postoperative pain, lighter postoperative anal edema, and differences between the two groups had a statistical significance （P〈 0.05）. There was no statistical significance in operation time, postoperative bleeding, postoperative hospitalization time, postoperative anal narrow （P〉 0.05）. PPH had an less injury to the rectal sphincter muscle in 6 months after operation. Conclusion In the treatment of m degree mixed hemorrhoids, procedure for prolapse and hemorrhoids is better than tissue-selecting therapy stapler, and it can better protect the physiological function of the anus. But surgeons should take the pull and discomfort into consideration.