超声刀联合混合痔外剥内扎术对Ⅲ期和Ⅳ期混合痔患者的疗效

Curative effect of harmonic scalpel combined with milligan-morgan hemorrhoidectomy of mixed hemorrhoids on patients with stage Ⅲ and Ⅳ of mixed hemorrhoids

目的探讨超声刀联合混合痔外剥内扎术治疗Ⅲ期和Ⅳ期混合痔患者的临床效果。方法回顾分析2015年7月~2016年8月我院收治的76例混合痔Ⅲ~Ⅳ期患者的临床资料,按照手术不同分为常规组(40例)与联合组(36例),其中常规组予以外剥内扎术,联合组使用超声刀联合外剥内扎治疗,比较两组患者的手术情况(手术时间、术中出血量、术后疼痛、肛缘水肿及创面愈合时间),术后3~5个月进行随访,观察术后复发情况及肛门狭窄度情况。结果联合组的手术时间、术中出血量、创面愈合时间均显著低于常规组(P<0.05);联合组Ⅰ、Ⅱ度水肿比例均显著低于常规组,差异均有统计学意义(P<0.05),术后疼痛Ⅰ~Ⅲ度所占比例差异无统计学意义(P>0.05);常规组患者术后复发率为15.00%,联合组为5.56%,两组比较差异无统计学意义(P>0.05);常规组肛周狭窄率为20.0%,显著高于联合组的2.78%(P<0.05)。结论与传统外剥内扎术治疗Ⅲ~Ⅳ期混合痔相比,超声刀联合混合痔外剥内扎术治疗可显著缩短手术时间、创面愈合时间,减少术中出血量,缓解术后创缘水肿情况,并可减少术后肛周狭窄等并发症。

Objective To investigate the curative effect of harmonic scalpel combined with milligan-morgan hemor- rhoidectomy of mixed hemorrhoids treating patients with stage III and IV of mixed hemorrhoids.Methods Clinical data of 76 patients with stage III and IV of mixed hemorrhoids treated in our hospital from July 2015 to August 2016 were retrospectively analyzed.The patients were divided into the routine group （n=40） and the combined group （n=36） accord- ing to different operation modes.The routine group was treated with milligan-morgan hemorrboidectomy while the com- bined group was treated with harmonic scalpel combined with milligan-morgan hemorrhoidectomy.The operative status （operative time,intraoperative bleeding volume,postoperative pain,anal edema and wound healing time） were compared between the two groups.All cases were followed up for 3-5 months after operation.The recurrence and anal stenosis were observed.Results The operative time,intraoperative bleeding volume and wound healing time of the combined group were significantly shorter or less than those of the routine group （P〈0.05）.Cases with I and II degree of edema in the combined group were significantly fewer than the routine group （P〈0.05）.There was no significant difference between the two groups in postoperative pain （P〉0.05）.The recurrence rate showed no significant difference between the two groups （15.00% vs. 5.56%） （P〉0.05）. The incidence of anal stenosis was significantly higher in the routine group than the combined group （20.00% vs. 2.78%） （P〈0.05）.Condusion Compared with traditional milligan-morgan hemorrhoidecto- my,harmonic scalpel combined with milligan-morgan hemorrhoideetomy can significantly shorten the operation time and wound healing time,reduce the intraoperative bleeding volume,alleviate postoperative wound edge edema and re- duce the postoperative complications such as anal stenosis in patients with stage III and IV of mixed hemorrhoids.