分段切除伴肛门整形术结合PPH治疗环形混合痔术后恢复、疼痛及肛门功能的观察

Observation on the short-term pain and long-term anal function in patients with circumferential mixed hemorrhoids treated by subsection excision and plastic operation combined with PPH

目的观察分段切除整形术联合痔上黏膜环切钉合术(PPH)治疗环形混合痔术后恢复、疼痛及肛门功能的情况。方法选择2013年6月至2015年6月本院收治的250例环形混合痔患者为研究对象,随机分为观察组和对照组(每组各125例),观察组采用分段切除伴肛门整形术结合PPH治疗,对照组采用混合痔外剥内扎注射术。比较两组手术时间、术中失血量、住院时间、切口愈合时间,观察术后12 h、1周及首次排便肛门疼痛情况以及术后半年肛门功能、肛门平整度。结果两组手术时间比较差异无统计学意义(P>0.05),观察组术中失血量、住院时间及切口愈合时间显著少于对照组,差异均有统计学意义(P<0.05)。观察组术后12 h及首次排便疼痛评分均显著低于对照组(P<0.05),两组术后1周肛门疼痛度比较差异无统计学意义(P>0.05)。观察组术后半年肛门功能正常率为99.20%、肛门平整度Ⅰ度为97.60%,分别均显著高于对照组(分别为89.60%及84.00%),差异均有统计学意义(P<0.05)。结论分段切除伴肛门整形术结合PPH治疗环形混合痔的总体疗效优于外剥内扎注射术,利于促进患者康复。

Objective To investigate the anal function of patients with circumferential mixed hemorrhoids at six months after segmental resection plastic surgery combined with procedure for prolapsed hemorrhoid（PPH）.Methods 250 patients with circumferential mixed hemorrhoids who were diagnosed and treated in our hospital from June 2013 to June 2015 were analyzed retrospectively.Patients were divided into the treatment group（n=125） and control group（n=125）.The treatment group was treated by segmental resection plastic surgery combined with PPH,and the control group was treated by external dissection and internal ligation of mixed hemorrhoids.The duration of operation,intraoperative blood loss,length of hospital stay,incision healing time and anal pain were recorded.Six months after operation,the patients were reexamined to assess the anal function and anal planeness.Results The duration of operation did not differ between the two groups（P〉0.05）.The intraoperative blood loss,length of hospital stay and incision healing time of the treatment group were significantly less or shorter than those of the control group（P〈0.05）.Anal pain at 1 week after operation did not differ between the two groups（P〉0.05）.Anal pain at 12 h after operation was significantly less in the treatment group than in the control group（P〈0.05）.Six months after operation,the rate of normal anal function and grade I anal planes in the treatment group（99.20% and 97.60%,respectively） were significantly higher than those in the control group（89.60% and 84.00%,respectively）（P〈0.05）.Conclusion Segmental resection plastic surgery combined with PPH can achieve favorable operation indicators,milder postoperative pain and well preserved long-term anal function.