选择性痔上黏膜切除钉合术结合外痔切除术治疗混合痔的临床研究

Clinical research on treating mixed hemorrhoids by selective hemorrhoid mucosal resection nail operation plus external hemorrhoid resection

目的:探究选择性痔上黏膜切除钉合术结合外痔切除术(TST联合外痔切除术)在疗效、术后并发症及肛门功能保护方面的优势。方法:选取符合纳入标准的Ⅲ~Ⅳ度痔患者,随机分为治疗组(TST联合外痔切除术)50例和对照组(外切内扎术)50例,观察两组患者的总体疗效、手术时间、创面愈合时间、术后并发症及术后肛管直肠压力变化情况。结果:两组治愈率均为100%,在术后出血、尿潴留方面的差异无统计学意义(P>0.05);但治疗组在手术时间、住院时间、满意度、术后水肿、肛门狭窄及肛门直肠测压方面优于对照组(P<0.05),同时基于肛门直肠测压层面讨论,TST联合外痔切除术可能对肛门功能有一定的恢复作用。结论:TST联合外痔切除术对Ⅲ~Ⅳ度痔患者的疗效与外切内扎术相当,但其术后并发症少,手术时间、住院时间短,在肛门功能保护方面也优于外切内扎术。TST联合外痔切除术是治疗严重痔病的微创技术,疗效有保证,术后并发症少,肛门功能损伤小,甚至可能有一定的肛门功能修复作用,值得临床推广。

Objective:To explore the advantages of selective hemorrhoid mucosal resection nail plus external hemorrhoidectomy in the efficacy,postoperative complications and anal function protection.Methods:100patients were randomly divided into the treatment group(received TST plus external hemorrhoidectomy)and control group(took exogenous ligation).The overall curative effects,operation time,wound healing time,postoperative complications and postoperative anal rectal pressure changes in groups were observed.Results:The cured was100%in both groups,and there was no significant difference of postoperative bleeding and urinary retention(P>0.05).However,the operation time,hospitalization time,satisfaction,postoperative edema,anal stenosis and anorectal manometry in the treatment group were better(P<0.05).At the same time,TST plus external hemorrhoidectomy may have a certain effect on anal function.Conclusion:The efficacy of TST plus external hemorrhoidectomy on gradeⅢ~Ⅳhemorrhoids is similar to that of external incision,but TST plus external hemorrhoidectomy with fewer postoperative complications,and is superior to external incision in shorter operative time,shorter hospital stays and anal function.TST plus external hemorrhoidectomy is a minimally invasive treatment of severe hemorrhoids,and worthy of clinical promotion.