DGHAL治疗与同期吻合器PPH术治疗Ⅲ度混合痔的临床研究比较

目的探讨多普勒超声引导下痔动脉结扎（DGHAL）治疗与同期吻合器痔上黏膜环切（PPH）治疗Ⅲ度混合痔的比较，评价DGHAL治疗Ⅲ度混合痔的临床应用价值。方法回顾性分析2015年9月至2016年9月收治的Ⅲ度混合痔患者60例，按照手术方式分为PPH术组（n=30），DGHAL术组（n=30），对比两组患者手术情况、住院情况、住院费用、早期并发症、远期复发及治愈等差异情况。结果DGHAL组的术中出血量（6．88±1．08）ml、住院费用8504．24元，较PPH组术中出血量（10．24±1．87）ml、住院费用13679．20元显著减少（P〈0．05）；而DGHAL组手术时间（31．83±3．37）min、平均住院时间（6．36±1．06）d与PPH组手术时间（33．94±7．79）min、平均住院时间（6．50±1．25）d相比，其差异均无统计学意义（P〉0．05）；术后2周，两组患者的早期并发症疼痛、尿潴留、轻度肛门失禁、轻度直肠狭窄、便后出血、切口水肿相比较，差异均无统计学意义（P〉0．05）；术后9个月远期随访，DGHAL组痔核脱出、反复出血症状较PPH组差异具有统计学意义（P〈0．05），同时远期治愈率DGHAL组与PPH组差异亦有统计学意义（P〈0．05）。结论DGHAL与吻合器PPH手术治疗中度痔疮相比，DGHAL具有微创、术中出血量少、住院费用低，远期痔核脱出及反复出血复发率低特点，可作为中度痔病推荐术式。

Objective To evaluate the clinical efficacy of Doppler guided haemorrhoidal artery ligation （ DGHAL ） in treatment of Ⅲ hemorrhoids, as with procedure for prolapse and hemorrhoids （ PPH ） . Methods 60 patients with Ⅲ haemorrhoids treated by our hospital from September 2015 to September 2016 were chosen, and they were divided into PPH group （ n=30 ） and DGHAL group （ n=30 ） according to operation method.The clinical data including operation information, hospitalization time and cost, intraoperative bleeding, the early incidence of postoperative complications, long-term recurrence, cure rate etc. They were compared respectively between two groups. Results The intraoperative blood loss was （ 6.88 ± 1.08 ） ml in the DGHAL group, and the hospitalization cost was 8504.24 yuan, which was significantly lower than that in the PPH group E （ 10.24 ± 1.87 ） ml, 13679.20 yuan ] （ P〈0.05 ） . The mean time of hospitalization was （ 6.36 ± 1.06 ） days in DGHAL group had no difference in PPH group （ P〉0.05 ） . ARer 2 weeks, there was no significant difference between the two groups in the early complications, such as pain, urinary retention, mild anal incontinence, mild rectal stenosis, posterior hematoma and incisional edema, In the long-term follow-up of 9 months, the hemorrhagic prolapse and recurrent hemorrhage in DGHAL group were statistically significant comparedwith PPH group （ P〈0.05 ） , while the long-term cure rate of DGHAL 27 cases and PPH group 20 cases were also statistically different （ P〈0.05 ） . Conclusion Compared with PPH group in the treatment of Ⅲ hemorrhoids, DGHAL is with minimally invasive, less blood loss, low hospital costs, long-term hemorrhoid recurrence and recurrence rate of bleeding characteristics, it can be recommended as Ⅲ hemorrhoid treatment.