PPH和STARR手术治疗重度脱垂痔的临床疗效比较

Clinical Comparison of PPH and STARR in Treatment of Severe Prolapsed Hemorrhoids

目的 比较吻合器痔上黏膜环切术(PPH)与经肛吻合器直肠切除术(STARR)治疗重度脱垂痔的临床疗效。方法 选择2015年1月至2016年3月北京市隆福医院收治的重度脱垂痔患者70例,根据治疗方法不同分为PPH组和STARR组,每组35例。PPH组行PPH手术,STARR组行STARR手术。观察两组患者的临床疗效、临床各项指标、术后疼痛及术后并发症等。结果 术后12个月,STARR组总有效率高于PPH组[97.14%(34/35)比74.29%(26/35)]( P <0.05)。两组患者手术时间、住院时间、恢复胃肠功能时间、术中出血量、进食时间比较差异均无统计学意义( P >0.05),STARR组住院费用高于PPH组( P <0.01)。术后1个月、6个月、12个月,两组视觉模拟评分(VAS)均呈下降趋势,且STARR组各时点VAS评分均低于PPH组( P <0.05),两组间、时点间、组间和时点间交互作用比较差异均有统计学意义( P <0.05)。STARR组总并发症发生率低于PPH组[2.86%(1/35)比 28.57 %(10/35)]( P <0.05)。结论 与PHH手术相比,STARR手术治疗重度脱垂痔效果显著,能有效缓解患者疼痛症状且术后并发症发生率低。

Objective To investigate the clinical effect of procedure for prolapse and hemorrhoids(PPH) and stapled trans-anal rectal resection(STARR) in the treatment of severe prolapse hemorrhoids. Methods A total of 70 patients with severe prolapse hemorrhoids admitted to Beijing Longfu Hospital from Jan. 2015 to Mar. 2016 were included in the study and divided into a PPH group and a STARR group,with 35 patients in each group according to the treatment method.The clinical indexes,postoperative pain,efficacy and postoperative complications were observed. Results At 12 months after operation,the total effective rate in the STARR group was higher than that in the PPH group [97.14%(34/35) vs 74.29%(26/35)]( P <0.05). There was no significant difference in operation time,hospitalization time,recovery time of gastrointestinal function,intraoperative blood loss and eating recovery time between the two groups( P >0.05).The hospitalization cost of the STARR group was higher than that of the PPH group( P <0.01). At 1 month,6 months and 12 months after operation ,visual analogue score(VAS) decreased in both groups, and the VAS score in the STARR group was lower than that in the PPH group at all time points( P <0.05).There was a significant difference in the interaction between the two groups, between time points,and group time point interactions( P <0.05).The total incidence of complications in the STARR group was lower than that in the PPH group [2.86%(1/35) vs 28.57%(10/35)]( P <0.05). Conclusion Compared with PHH,STARR has a significant effect in the treatment of severe prolapsed hemorrhoids,which can effectively relieve patients′ pain symptoms,and has a low incidence of postoperative complications.