外剥内扎联合侧方外括约肌部分切断术治疗混合痔的临床疗效

The Curative Effect of Milligan-Morgan Combined with External Sphincterotomy in the Treatment of Mixed Hemorrhoid

目的探讨外剥内扎联合侧方外括约肌皮下及浅层部分切断术治疗混合痔的临床疗效。方法将2013年1月—2016年1月大连市瓦房店妇婴医院肛肠科收治的80例混合痔患者随机分为治疗组(40例)与对照组(40例),其中治疗组患者采用外剥内扎联合侧方外括约肌皮下及浅层部分切断术治疗,对照组患者单纯采用外剥内扎术治疗。对比观察两组患者术后肛缘水肿、痔残留、排便费力、首次排便出血及疼痛等并发症的发生情况。结果两组患者均顺利完成手术,其中治疗组患者术后出现肛缘水肿者10例,首次排便疼痛评分<2分者30例,首次排便出血评分<2分者32例,痔残留者5例,排便费力者5例;对照组患者术后出现肛缘水肿者32例,首次排便疼痛评分<2分者10例,首次排便出血评分<2分者20例,痔残留者28例,排便费力者30例。两组患者术后出现肛缘水肿、首次排便疼痛评分<2分、首次排便出血评分<2分、痔残留及排便费力的患者例数对比采用四格表资料的卡方检验,χ~2值分别为24.260、20.000、7.912、27.290及31.750,P均<0.01,差异具有统计学意义。结论外剥内扎联合侧方外括约肌皮下及浅层部分切断术治疗混合痔,可有效减少术后肛缘水肿、痔残留、排便费力、首次排便出血及疼痛等并发症的发生率,缩短术后创面愈合时间,提高患者生活质量,值得临床推广应用。

Objective To explore the curative effect of milligan-morgan combined with external sphincterotomy in the treatment of mixed hemorrhoid. Methods 80 patients with mixed hemorrhoid, admitted to Anorectal Surgery Depart- ment, Wafangdian Women and Infants Hospital from January 2013 to January 2016, were divided into treatment group （40 cases） treated with milligan-morgan combined with external sphincterotomy, and control group （40 cases） treated with mil- ligan-morgan only. The following things were analyzed and compared： anal edema, hemorrhoid residuals, exertion in dell- cation, ant/ bleeding and pain during the first defecation. Results Operations on patients in the two groups were performed successfully. In treatment group, 10 patients suffered from anal edema after operation, 30 patients got less titan 2 points in terms of pain during the first defecation, 32 patients got less than 2 points in terms of bleeding during the first defecation, 5 patients had hemorrhoid residuals and 5 patients got exertion in defecation. In control group, 32 patients suffered from anal edema after operation, 10 patients got less than 2 points in terms of pain during the first defecation, 20 patients got less than 2 points in terms of bleeding during the first defecation, 28 patients had hemorrhoid residuals and 30 patients got exertion in defecation. Chi square test of fourfold table was used for the comparison of patient quantity （ those who suffered anal edema, who got less than 2 points in terms of pain during the first defecation, who got less than 2 in terms of bleeding during the first defecation, who had hemorrhoid residuals and who got exertion in defecation） and the results showed statistically signif- icant difference （X2 values =24. 260, 20. 000, 7. 912, 27. 290 and 31. 750, all P 〈 O. O1 ）. Conclusion Milligan-Mor- gan combined with external sphincterotomy in the treatment of mixed hemorrhoid can reduce incidence of complications such as anal edema, hemorrhoid residual, exertion in defecation, bleeding during the first defecation and pain. It should be pro- rooted in clinical practice as it can shorten healing time after surge~, and improve patients＇ quality of life.