内痔分段结扎、外痔环形切除联合肛缘皮桥弧状切除缝合术治疗环形混合痔的疗效观察

Clinical effect of hemorrhoids segmented ligation and external hemorrhoid ring-resection combined with perianal skin bridge arc resection and suture in treatment of circumferential mixed hemorrhoids

目的观察内痔分段结扎外痔环形切除联合肛缘皮桥弧状切除缝合术治疗环形混合痔的临床疗效。方法纳入本院2015年5月至2016年5月收治的120例环形混合痔患者作为研究对象,随机分为3组,每组各40例。A组行传统外剥内扎术,B组行痔上黏膜吻合器钉合术,C组行内痔分段结扎外痔环形切除联合肛缘皮桥弧状切除缝合术。比较三组治疗疗效、手术基本情况、术后并发症及复发率。结果三组手术近期疗效无显著性差异(P>0.05)。C组术中出血量和住院时间显著少于A、B两组(P<0.05)。B、C两组患者术后1 d、3 d及1 w时VAS疼痛评分均显著低于术前和A组(均P<0.05)。三组术后并发症总发生率差异显著(P<0.05),三组术后复发率无显著性差异(P>0.05)。结论内痔分段结扎外痔环形切除联合肛缘皮桥弧状切除缝合术治疗环形混合痔疗效显著,术后恢复快,并发症少。

Objective To research the effect of hemorrhoids segmented ligation and external hemorrhoid ring-resection combined with perianal skin bridge arc resection and suture in treatment of circumferential mixed hemorrhoids. Methods 120 patients with circumferential mixed hemorrhoids were recruited and randomly assigned to 3 groups,with 40 cases in each group. Group A received traditional Milligan Morgan,group B procedure for prolapse and hemorrhoids（PPH）,and group C hemorrhoids segmented ligation and external hemorrhoid ring-resection combined with perianal skin bridge arc resection and suture. The curative effect,indices of operation,postoperative complications and recurrence rate were compared among the three groups. Results There was no significant difference among the three groups in short-term curative effect（P〉0.05）. The amount of bleeding and hospital stay in group C were less than those in group A and B（P〈0.05）. The VAS pain score in group B and C at 1 day,3 rdday and 1 week after operation were significantly lower than preoperative indices,as well as than those in group A（P〈0.05）. The incidence of postoperative complications did not differ significantly among the three groups（P〈0.05）. There was no significant difference in the recurrence rate among the three groups（P〉0.05）. Conclusion Hemorrhoids segmented ligation and external hemorrhoid ring to remove combined with perianal skin bridge arc resection and suture have good clinical effect,improve postoperative recovery and fewer complications in the treatment of circumferential mixed hemorrhoids.