PPH联合小“V”切口外痔剥除术治疗重度混合痔的效果研究

Effect of PPH combined with small ‘V' incision for the treatment of severe mixed hemorrhoids

目的探讨吻合器痔上黏膜环切术(PPH)联合小"V"切口外痔剥除术在重度混合痔治疗中的临床效果。方法选择本院收治的重度混合痔患者118例,随机分为对照组(行PPH术)与观察组(行PPH联合小"V"切口外痔剥除术),每组各59例。比较两组手术疗效以及术后1 d、3 d、7 d的疼痛水平,采用肛肠压力检测仪测定两组术前、术后1个月的肛管直肠压水平,并观察术后并发症情况。结果观察组总有效率(96.61%)高于对照组(83.05%),差异有统计学意义(P<0.05)。观察组术后7 d的VAS评分为(1.08±0.97)分,低于同时段对照组,差异有统计学意义(P<0.05)。观察组术后肛管舒张压(1.93±1.56)k Pa低于对照组、肛管最大收缩压(19.56±2.68)k Pa高于对照组,差异均有统计学意义(均P<0.05)。观察组排便障碍发生率(5.08%)低于对照组(16.95%),差异有统计学意义(P<0.05)。结论 PPH联合小"V"切口外痔剥除术治疗重度混合痔总体效果良好,未加重患者术后疼痛,且能较好的保持肛门功能,具有一定的临床应用价值。

Objective To investigate the effect of procedure for prolapse and hemorrhoids（PPH） combined small ‘V＇ incision for the treatment of severe mixed hemorrhoids. Methods 118 patients with severe mixed hemorrhoid admitted in our hospital were recruited and randomly assigned to control group and treatment group, with 59 patients in each group. Control group received PPH surgery, and treatment group received PPH in combination with small‘V＇ incision external hemorrhoid dissection. Surgical curative effect and levels of pain at postoperative 1 d, 3 d, and 7 d were compared between the two groups. Anorectal pressure detector was used to measure anorectal pressure before and 1 month after surgery. Postoperative complications were recorded. Results The total effective rate was96.61% for the treatment group, which was higher than in the control group（83.05%）, and the difference was statistically significant（P〈0.05）. The VAS pain score at postoperative 7 d was（1.08 ± 0.97） points in the treatment group, which was lower than that in the control group at the same time point, and the difference was statistically significant（P〈0.05）. Postoperative anal diastolic pressure was significantly lower（1.93±1.56） k Pa and anal maximum systolic pressure significantly higher（19.56±2.68） k Pa in the treatment group than in the control group. These differences were statistically significant（both P〈0.05）. The incidence of defecation in the treatment group was 5.08%, which was significantly lower than in the control group（16.95%）, and the difference was statistically significant（P〈0.05）. Conclusion PPH combined with small ‘V＇ incision has favorable effectiveness for the treatment of severe mixed hemorrhoids. It does not exacerbate postoperative pain. It could better preserve anal function. It has value for clinical application.