不同手术方式联合亚甲蓝混合液皮下注射治疗混合痔合并肛周湿疹的临床效果观察

Different operation Methods combined with compound methylene blue injection for the treatment of mixed hemorrhoids complicated with perianal eczema

目的探讨不同手术方式联合亚甲蓝混合液皮下注射治疗混合痔合并肛周湿疹的临床效果。方法将本院94例混合痔合并肛周湿疹患者随机分为观察组(皮瓣游离固定术联合亚甲蓝混合液皮下注射)与对照组(外剥内扎术联合亚甲蓝混合液皮下注射),每组各47例。对比两组手术相关指标(手术时间、术中出血量)及术后康复指标(肛周水肿时间、创面愈合时间、痔核脱落时间、住院时间),记录术前、术后3个月肛管静息压、肛管最大收缩压、Wexner评分,观察术后3个月内并发症发生率。结果观察组创面愈合时间、痔核脱落时间显著短于对照组(均P<0.05)。两组手术时间、术中出血量、肛周水肿时间、住院时间差异均无统计学意义(均P>0.05)。两组手术前后肛管静息压、肛管最大收缩压差异均无统计学意义(均P>0.05)。观察组术后Wexner评分低于对照组(P<0.05)。观察组疼痛、出血、水肿、痔核皮赘残留发生率均低于对照组(均P<0.05)。结论皮瓣游离固定术联合亚甲蓝混合液皮下注射治疗混合痔合并肛周湿疹可缩短创面愈合时间、痔核脱落时间,保护肛门功能,降低肛门失禁风险及术后并发症发生率,有一定的临床应用价值。

Objective To investigate the clinical effect of different surgical methods combined with compound methylene blue injection for the treatment of mixed hemorrhoids complicated with perianal eczema. Methods 94 patients of mixed hemorrhoids complicated with perianal eczema treated in our hospital were randomly assigned to treatment group（flap fixation combined with compound methylene blue injection） and control group（Milligan Morgan hemorrhoidectomy combined with compound methylene blue injection）. There were 47 patients in each group. The operative indices（operation duration and the amount of bleeding during operation）and postoperative rehabilitation indices（perianal edema duration, time to wound healing, time to hemorrhoids shedding, andhospitalization duration） were compared between the two groups. The anal rest pressure, anal canal maximum systolic pressure and Wexner score were recorded before and 3 months after operation, and the complication rate was observed within 3 months after operation. Results Time to wound healing and time to hemorrhoids shedding was shorter in the treatment group than in the control group（P 〈 0.05）. There was no significant difference between the two groups in terms of operation duration, intraoperative bleeding volume, perianal edema duration and hospitalization duration（P 〉 0.05）. There was no significant difference in anal rest pressure and anal maximum systolic pressure between the two groups（P 〉 0.05）. The Wexner score was lower in the treatment group than that in the control group（P 〈 0.05）. Incidence rate of pain, bleeding, edema, hemorrhoids epicanthus residual was lower in the treatment group than in the control group（P 〈 0.05）. Conclusion Free flap fixation combined with compound methylene blue injection can shorten time wound healing and time to hemorrhoids shedding for the treatment of mixed hemorrhoids complicated with perianal eczema, which can protect anal function, reduce the risk of anal incontinence and the incidence of postoperative complications. It has high clinical value.