吻合器痔上黏膜环切钉合术联合外剥内扎术治疗老年人环形混合痔的疗效分析

Analysis of effect of procedure for prolapse and hemorrhoids stapling surgery combined with disection and iigation in the treatment of annular mixed hemorrhoids in the elderly

目的 探讨吻合器痔上黏膜环切钉合术（PPH）联合外剥内扎术治疗老年人环形混合痔的疗效.方法 收集环形混合痔老年患者80例,采用随机数字表法将其分为两组,每组40例.对照组给予外剥内扎术治疗,研究组则加施PPH,比较两组治疗前后临床症状评分、总有效率、相关临床指标、并发症发生率与术后肛门狭窄情况.结果 研究组治疗后各维度临床症状评分均显著低于对照组（均P〈0.01）;研究组术后住院时间、24 h疼痛程度、首次排便疼痛时间、总疼痛持续时间、水肿时间、带血时间分别为（5.57±1.35）d、（4.47±1.14）分、（24.75±4.52）min、（4.12±1.05）d、（3.51±0.85）d、（4.01±0.94）d,均显著优于对照组的（8.07±1.49）d、（5.68±1.06）分、（30.77±5.54）min、（6.33±1.29）d、（4.93±1.02）d、（5.39±1.36）d,差异均有统计学意义（t=7.864、3.657、5.325、8.403、6.764、5.279,均P〈0.01）;研究组术后1个月与2个月术后肛门狭窄情况显著优于对照组,差异均有统计学意义（Z=-3.071、-2.961,均P〈0.01）;研究组总有效率97.5％,明显高于对照组的80.0％（χ2=4.507,P〈0.05）;研究组并发症发生率明显低于对照组（χ2=6.270,P〈0.05）.结论 PPH联合外剥内扎术治疗老年人环形混合痔的疗效显著,具有借鉴意义.

 Objective To investigate the curative effect of procedure for prolapse and hemorrhoids （ PPH） stapling surgery combined with disection and ligation in the treatment of annular mixed hemorrhoids in the elderly . Methods 80 elderly patients with annular mixed hemorrhoids were enrolled ,and they were randomly divided into two groups according to the digital table ,40 cases in each group.The patients in the control group were treated with disection and ligation .The study group was additionally treated with PPH .The clinical symptoms score , the total effective rate, the related clinical index , the complication rate and the postoperative anal stenosis were compared between the two groups before and after treatment .Results Compared with the control group , the scores of the patients in the study group were significantly lower（all P〈0.01）.The postoperative hospital stay,the time of pain, the duration of the first defecation pain ,the duration of the total pain ,the time of edema and the time of blood flow of the study group were （5.57 ±1.35） d,（4.47 ±1.14） points,（24.75 ±4.52） min,（4.12 ±1.05） d,（3.51 ± 0.85）d,（4.01 ±0.94） d,respectively,which were significantly lower than those of the control group [（8.07 ± 1.49）d,（5.68 ±1.06）points,（30.77 ±5.54）min,（6.33 ±1.29）d,（4.93 ±1.02）d,（5.39 ±1.36）d],the differences were statistically significant （t =7.864,3.657,5.325,8.403,6.764,5.279,all P 〈0.01）.The total effective rate of the study group was 97.5%,which was significantly higher than 39.9 % of the control group （χ2 =4.507 ,P〈0.05 ） .The overall complication rate of the study group was significantly lower than that of the control group（χ2 =6.270,P〈0.05）.Conclusion The PPH stapling surgery combined with disection and ligation in the treatment of annular mixed hemorrhoids in the elderly is an effective method .