吻合器痔上黏膜环切术联合外剥内扎手术治疗Ⅲ-Ⅳ度环状混合痔的疗效及对患者肛门功能的影响

Curative Effect of Procedure for Prolapse and Hemorrhoids Combined with Milligan-morgan Haemorrhoidectomy in Treatment of III-IV Degree Mixed Hemorrhoids and Its Effect on Anal Function of Patients

目的:研究吻合器痔上黏膜环切术(PPH)联合外剥内扎手术(MMH)治疗Ⅲ-Ⅳ度环状混合痔的疗效及对患者肛门功能的影响。方法:选择2016年3月~2018年3月我院收治的III-IV度环状混合痔患者128例为研究对象,将入选患者按照随机数字表法分为MMH组(n=58,采用MMH治疗)和联合组(n=70,采用PPH联合MMH治疗),比较两组手术指标及术后恢复情况,术后对两组患者进行为期3个月的随访,随访结束后,比较两组治疗疗效、肛门功能以及并发症的发生情况。结果:与MMH组比较,联合组手术出血量明显更少,住院时间、伤口愈合时间明显更短,各时间点的疼痛评分明显降低(P<0.05)。与MMH组比较,联合组治疗总有效率升高,差异有统计学意义(P<0.05)。与MMH组比较,联合组患者肛管静息压、肛管高压带长度、直肠肛门抑制反射阳性率均升高,肛管最大收缩压降低(P<0.05),但两组直肠静息压比较差异无统计学意义(P>0.05)。联合组并发症发生率为10.00%(7/70),低于MMH组的34.48%(20/58),差异有统计学意义(P<0.05)。结论:较传统的MMH单独治疗,PPH联合MMH治疗Ⅲ-Ⅳ度环状混合痔具有更好的效果,可以缩短术后恢复时间,改善术后疼痛程度及肛门功能,且安全性较高。

Objective:To study curative effect of procedure for?prolapse and hemorrhoids(PPH)combined with milligan-morgan haemorrhoidectomy(MMH)in treatment of III-IV degree mixed hemorrhoids and its effect on anal function of patients.Methods:128 patients with III-IV degree mixed hemorrhoids who were treated in our hospital from March 2016 to March 2018 were selected as research object,the enrolled patients were divided into MMH group(n=58,treated with MMH)and combined group(n=70,treated with PPH combined with MMH)according to random number table method.Operation indexes and postoperative recovery of two groups were compared.The patients in the two groups were followed up for 6 months after operation.After the end of the follow-up,the curative effect,anal function and complications of the two groups were compared.Results:Compared with the MMH group,surgical bleeding volume in the combined group was significantly less,hospital stay,wound healing time were shorter,and the pain scores at each time point were significantly lower(P<0.05).Compared with group MMH,the total effective rate of combined group was significantly increased,and the difference was statistically significant(P<0.05).Compared with MMH group,the anal canal resting pressure,the length of anorectal hyperbaric zone and anorectal reflex positive rate in the combined group were significantly increased,anal maximum systolic pressure was decreased(P<0.05),however,there was no significant difference in rectal resting pressure between the two groups(P>0.05).The incidence of complications in the combined group was 10.00%(7/70),which was significantly lower than 34.48%(20/58)in the MMH group,and the difference was statistically significant(P<0.05).Conclusion:Compared with the traditional MMH treatment alone,PPH combined with MMH has better effect in the treatment of III-IV degree mixed hemorrhoids.It can shorten postoperative recovery time,improve postoperative pain level and anal function,and it has higher safety.