选择性痔上黏膜吻合术联合外剥内扎术对混合痔患者肛肠动力恢复及复发的影响

Effect of mixed hemorrhoid after tissue-selecting therapy stapler combined with Milligan-Morgan hemorrhoidectomy on recovery and recurrence of anorectal motility in mixed hemorrhoid patients

目的探讨选择性痔上黏膜吻合术(TST)联合外剥内扎术治疗混合痔患者的疗效,以及该术式对患者肛肠动力恢复及复发的影响。方法选择2014年12月至2016年12月泰安市泰山区人民医院诊治的混合痔患者65例,依据治疗方法分为对照组(33例,给予外剥内扎术治疗)和联合组(32例,外剥内扎术+TST术治疗),分别于术前、术后6个月消化道压力监测仪测定肛肠动力,包括肛管高压区长度(HPZ)、静息压(ARP)、最大收缩压(MSP)水平;随访6个月,统计分析两组患者疗效、并发症、复发情况。结果两组均无手术失败病例,对照组手术时间明显低于联合组,对照组术中出血量明显高于联合组,差异有统计学意义(t=5.627、14.939,均P<0.001);联合组和对照组患者治疗有效率分别为93.75%(30/32)、87.88%(29/33),差异无统计学意义(χ~2=1.513,P=0.469);两组术前肛肠动力水平差异无统计学意义,但术后6个月比较,联合组术后HPZ、ARP、MSP水平显著高于对照组(χ~2=5.791、5.120、4.978,均P<0.01);术后6个月时,联合组的并发症发生率、复发率明显低于对照组,差异有统计学意义(χ~2=4.447、5.107,P=0.035、0.024)。结论与外剥内扎术比较,TST联合外剥内扎术治疗混合痔患者疗效确切,可有效减少并发症的发生,有利于肛肠动力恢复及预防复发,值得临床作进一步推广。

Objective To investigate the curative effect of tissue-selecting therapy stapler（TST） combined with Milligan-Morgan hemorrhoidectomy in mixed hemorrhoids patients, and the influences on anorectal motility recovery and recurrence. Methods From December 2014 to December 2016, sixty-five cases of mixed hemorrhoids diagnosed by People’s Hospital of Taishan District were selected. According to the treatment methods, they were divided into control group（33 cases, underwent Milligan-Morgan hemorrhoidectomy） and combined group（32 cases, underwent Milligan-Morgan hemorrhoidectomy＋TST）. The anorectal motility levels, including length of high pressure zone（HPZ）, anal anal resting pressure（ARP）, maximums systolic pressure（MSP）, were measured at preoperation and 6 months after the operation. The curative effect, complications and recurrence between the two groups were statistically analyzed after 6 months of follow-up. Results There was no surgical failure in the two groups. Operation time of the control group was significantly less than that of the combined group, the intraoperative bleeding of the control group was significantly higher than that in the combined group, with statistically significant differences（t=5.627, 14.939, both P〈0.001）. The effective rates of the combined group and the control group were 93.75%（30/32）, 87.88%（29/33）, respectively, and the difference was not statistically significant（χ^2=1.513, P=0.469）. There was no significant difference in anorectal motility between the two groups before operation. But after6 months, the levels of HPZ, ARP and MSP in the combined group were significantly higher than those in the control group（χ^2=5.791, 5.120, 4.978, all P〈0.01）. And 6 months after operation, the complication rate and recurrence rate in the combined group were significantly lower（χ^2=4.447, 5.107, P=0.035, 0.024）. Conclusions Compared with Milligan-Morgan hemorrhoidectomy, TST combined with Milligan-Morgan hemorrhoidectomy is curative for the mixed hemorrhoids patients. It can effectively reduce the incidence of complications, prevent recurrence, is good for anorectal dynamic recovery, and worthy of further promotion in clinical practice.