PPH术治疗出口梗阻型便秘的临床研究

Clinical Study of PPH in the Treatment of Outlet Obstructive Constipation

目的 探讨吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids, PPH)与传统缝扎术治疗出口梗阻型便秘患者的不同临床效果。方法 选择2017年10月至2018年10月在我院诊断并手术治疗的出口梗阻型便秘患者共140例,其中80例接受PPH(观察组),另60例采用传统直肠黏膜柱状缝扎术(对照组)。比较两组手术相关指标、术后疼痛评分、肛肠动力指标、复发率。结果 两组患者均能顺利完成手术,无需中转其他术式。手术相关指标比较发现,观察组平均需要手术时间较对照组缩短,术后1 d、3 d和7 d疼痛VAS评分降低(P<0.05)。观察组术后1周临床总有效率显著高于对照组(P<0.05)。观察组术后HPZ、ARP、MSP明显高于对照组(P<0.05)。随访6个月,观察组复发率明显低于对照组(P<0.05)。结论 PPH具有微创、时间短、效果确切的优点,是治疗出口梗阻型便秘的首选术式,对减轻术后疼痛,促进快速痊愈,恢复排便功能,降低远期并发症具有较好的应用价值。

Objective To investigate the clinical effects of the procedures for prolapse and hemorrhoids (PPH) and conventional sutures in the treatment of patients with outlet obstruction constipation.Methods A total of 140 patients with outlet obstruction constipation diagnosed and treated in our hospital from October 2017 to October 2018 were enrolled,60 of whom underwent conventional rectal mucosal column suture (the control group) and 80 received PPH (the observation group).The surgical related indicators,postoperative pain score,anorectal dynamic index,recurrence rate and clinical efficacy of the two groups were compared.Results All the patients successfully completed the operation without conversion to other procedures.Comparison of surgical related indicators found that average operation time of the observation group was shorter than that of the control group,and the pain VAS score decreased at 1d,3d and 7d after operation (P<0.05).The total effective rate of the observation group was significantly higher than that of the control group at 1 week after operation (P<0.05).The HPZ,ARP and MSP in the observation group were significantly higher than that of the control group (P<0.05).During the 6 months follow-up period,the recurrence rate of the observation group was significantly lower than the control group (P<0.05).Conclusion PPH has the advantages of minimally invasion,shorter operation time and more definite effect.It is the first choice for the treatment of outlet obstructive constipation.It can relieve postoperative pain,restore bowel function,promote rapid recovery and reduce long-term complications,which has a good application value.