超声下痔结扎术治疗混合痔的临床观察

oppler guided hemorrhoidal artery ligation for mixed hemorrhoids

目的观察超声下痔动脉结扎术(DG-HAL)治疗混合痔术后患者肛门功能的改善作用及并发症发生情况。方法选取2012年1月至2016年4月本院收治的84例混合痔患者为研究对象,随机分为观察组与对照组(每组各42例)。观察组行DGHAL,对照组行吻合器痔上黏膜环切术(PPH),比较两组手术相关指标、术后恢复情况、手术前后肛门直肠压力及术后并发症发生率。结果观察组手术时间为(17.42±5.10)min、术中出血量为(6.01±2.24)m L,均分别少于对照组,差异均有统计学意义(P<0.05)。观察组术后1 d疼痛评分、住院时间及创面愈合时间均分别少于对照组,差异均有统计学意义(P<0.05)。术前,两组肛门直肠压力各项指标差异无统计学意义(P>0.05);术后1个月,两组组内直肠静息压(RRP)、肛管最大收缩压(ASP)差异无统计学意义(P>0.05),肛管静息压(ARP)、肛管高圧帯长度(HPZ)较术前有下降,差异有统计学意义(P<0.05),各项指标组间差异无统计学意义(P>0.05)。观察组并发症总发生率为14.29%,显著低于对照组(33.33%),差异有统计学意义(P<0.05)。结论 DGHAL治疗混合痔对患者肛门功能的改善效果与PPH相当,前者更利于患者恢复、并发症发生率较低,具有较好的临床实用价值。

Objective To investigate the effects on anal function and the incidence of complications after Doppler guided hemorrhoidal artery ligation（DG-HAL）.Methods Eighty-four patients with mixed hemorrhoids who were treated in our hospital from January 2012 to April 2016 were randomized into treatment group and control group,with 42 cases in each group.The treatment group was treated by DG-HAL and the control group by procedure for prolapse and hemorrhoids（PPH）.The operation time,intraoperative blood loss,postoperative recovery,preoperative and postoperative anorectal pressure,and incidence of postoperative complications were compared between the two groups.Results The operation time and intraoperative blood loss in the treatment group [（17.4±5.10） min,（6.01±2.24） mL] were both significantly lower than those in the control group（P〈0.05）.The pain score of 1 d postoperative,length of stay,and wound healing time in the treatment group were both significantly lower than those in the control group（P〈0.05）.Before operation,there were no significant differences in anorectal pressure indexes between the two groups（P〉0.05）.1 month after operation,there were no significant changes in scores of rectal rest pressure（RRP） and anal maximal contraction pressure（ASP） within each group（P〉0.05）,while anal rest pressure（ARP） and length of high pressure zone（HPZ） significantly reduced than baseline（P〈0.05）.There were no significant differences in these indices between the two groups（P〉0.05）.The overall incidence of complications（14.29%） in the treatment group was significantly lower than that in the control group（33.3%,P〈0.05）.Conclusion DG-HAL and PPH had similar clinical effects on on anal function.However,DG-HAL had better recovery and lower incidence of complications.