荷包缝合术在混合痔外剥内扎术中的应用研究

Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids

目的探讨荷包缝合术联合外剥内扎术治疗混合痔的临床疗效。方法前瞻性纳入2015年6月至2016年6月江苏省中医院收治的70例Ⅲ~Ⅳ度内痔及混合痔患者,并按照简单随机数字表法,将70例患者随机分为联合手术组与对照组,每组各35例。联合手术组采用荷包缝合术联合外剥内扎术,对照组采用外剥内扎术。比较2组患者在创面愈合时间、临床疗效、住院时间、手术时间及术后并发症(术后肛门疼痛、肛缘水肿、术后出血、排尿障碍、皮赘形成、肛门直肠狭窄)等方面的差异。结果 2组患者在临床疗效、手术时间及肛门直肠狭窄方面比较,差异均无统计学意义(P>0.05);联合手术组在术后第1天、第3天及第5天肛门疼痛和肛缘水肿评分均低于对照组,差异有统计学意义(P<0.05),而2组在术后第7天肛门疼痛及肛缘水肿评分比较,差异无统计意义(P>0.05);联合手术组在创面愈合时间、住院时间、术后出血、排尿障碍及皮赘形成方面均优于对照组,其差异有统计学意义(P<0.05)。结论荷包缝合术联合外剥内扎术治疗混合痔可有效减轻术后疼痛、减少术后并发症、加速创面愈合,符合现代微创理念,值得临床上推广应用。

Objective To investigate the clinical efficacy of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids. Methods Seventy patients with III- IV internal henmorrhoids and mixed hemorrhoids who were admitted into Jiangsu Provincial Hospital of Traditional Chinese Medicine form June 2015 to June 2016 were enrolled. The patients were randomly divided into two groups： the combined operativ group and control group. The combined operativ group in which 35 cases were treated by pouched suture plus external dissection and internal ligation, and the control group in which 35 cases were treated by external dissection and internal ligation. The wound healing time, clinical curative effect, hospital stay, the operative time and postoperative complications （postoperative pain, edema, postoperative bleeding volume, urination difficulties, residual skin tag, anorectal stenosis） between two groups were compared. Results No significant difference were found in the clinical curative effect, the operative time and anorectal stenosis in two groups （P〉0.05）. The visual analogue scale （VAS） scores and the edema scores of the combined operativ group on the first day, the third day, and the fifth day after operation were lower than those of control group, the difference was statistically significant （P〈0.05）, while there were no statistically significant on the seventh day after operation in two groups （P〉0.05）. The wound healing time, hospital stay, postoperative bleeding volume, urination difficulties, and residual skin tag in the combined operativ group were significantly shorter or lower than those in the control group （P〈0.05）. Conclusion Pouched suture plus external dissection and internal ligation has the advantages of less pain, fewer complications and quicker recovery, it also meets the modern concept of minimally invasive, so it is worthy of popularization and application.