自动痔疮套扎内痔套扎联合外痔翼形切除缝合术治疗老年环状混合痔的临床疗效研究

Internal Hemorrhoids Ligation through RPH Combined with Wing-like Resection & Suture for External Hemorrhoids in the Treatment of Circumferential Mixed Hemorrhoids in the Elderly

目的探讨自动痔疮套扎(RPH)内痔套扎联合外痔翼形切除缝合术治疗老年环状混合痔的临床疗效。方法选取2016年12月-2018年03月于我院收治的老年环状混合痔患者92例,采用随机字母表法将所有患者分为观察组与对照组,对照组应用传统外剥内扎术(Milligan-Morgan)治疗,观察组应用RPH内痔套扎联合外痔翼形切除缝合术治疗,观察2组患者临床治疗效果,比较术后疼痛评分(VAS)、手术治疗情况、肛门功能和并发症发生率。结果观察组患者治疗有效率较对照组高(95.65%vs 78.26%,P<0.05);治疗后观察组术后24 h与首次排便的VAS评分均较对照组低(P<0.05);与对照组比较,观察组手术时间和术后恢复时间明显变短,术中出血量明显减少(P<0.05);治疗后观察组肛管静息压、肛管舒张压和最大收缩压均较对照组高,而最长收缩时间较对照组低(P<0.05);观察组并发症发生率显著低于对照组(10.87%vs 30.43%,P<0.05)。结论 RPH内痔套扎联合外痔翼形切除缝合术治疗老年环状混合痔可促使肛门功能得到有效恢复,缩短手术时间,并明显减少术后疼痛以及术后并发症,治疗效果显著,值得临床推广应用。

Objective To explore the clinical effect of internal hemorrhoid ligation through Ruiyun procedure for hemorrhoids(RPH)combined with wing-like resection&suture for external hemorrhoids on circumferential mixed hemorrhoids in the elderly.Methods92elderlywith circumferential mixed hemorrhoids hospitalized during the period fromDec.,2016 t oMar.,2018 were randomly divided into2groups:observation group and control group;traditionalMilligan-Morgan operationwas performed on the elderly in control group while internal hemorrhoid ligation through RPH combined with wing-like resection&suture for external hemorrhoid was performed on the elderly in observation group;the clinical effects in the 2 groups were observed and a comparative study was made to VAS scores,surgical treatment,anal function and complication incidence between the 2 groups.Results The effective rate in observation group was higher than that in control group(95.65%vs78.26%,P<0.05);the VAS scores24hours after operation and after first defection in observation group were both lower than those in control group(P<0.05);the operation time length and the time for post-operative recovery in observation group were shorter than those in control group and the bleeding volume in operation was much smaller in observation group(P<0.05);after operation,the anal resting pressure(ARP),the anal relaxant pressure and the anal maximal contraction pressure(AMCP)were higher than those in control group while the anal longest contraction time(ALCT)was shorter than that in control group(P<0.05);the incidence of complications in observation group was much lower than that in control group(10.87%vs30.43%,P<0.05).Conclusions Internal hemorrhoid ligation through RPH combined with wing-like resection&suture for external hemorrhoid is of obvious effect on circumferential mixed hemorrhoids in the elderly,it can promote the recovery of anal function effectively,shorten the operation time length,reduce the post-operative pain and decrease the incidence of complication,worthy of wider clinical application.