吻合器痔上黏膜环切术与传统外剥内扎术治疗痔的疗效和安全性对比

Comparing the efficacy and safety of procedure for prolapse and hemorrhoids and conventional Milligan-Morgan hemorrhoidectomy

目的:对比分析吻合器痔上黏膜环切术(PPH)与传统外剥内扎术(MMH)治疗Ⅲ期和Ⅳ期混合痔的疗效和安全性。方法:采用病例对照研究将我科2016年6月~2018年6月期间符合收治条件的Ⅲ期和Ⅳ期混合痔的患者共94例,随机分为PPH组48例和MMH组46例,比较两组手术的治疗效果和近远期疗效。结果:PPH组总体治疗有效率为97.9%(47/48),MMH组总体治疗有效率为93.5%(43/46);与MMH组相比,PPH组患者的手术时间、术中出血量、术后住院时间、术后疼痛持续时间和术后VAS疼痛评分等均减少,差异有统计学意义(P<0.01);术后出现肛门坠胀的发生率较低,差异有统计学意义(P<0.05),而两组患者术后出现出血需再次手术止血、尿潴留、肛缘水肿、肛门狭窄、便秘、里急后重感和排便异常的发生率无明显差异(P>0.05)。结论:PPH治疗Ⅲ期和Ⅳ期混合痔临床疗效确切,操作简便,手术安全性高,术后并发症少,值得基层医院推广使用。

Objective: To compare the efficacy and safety of procedure for prolapse and hemorrhoidectomy (PPH) and conventional Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of mixed hemorrhoids in stage Ⅲ and Ⅳ. Methods :By case-control study,a total of 94 eligible patients with mixed hemorrhoids in stage Ⅲ and Ⅳ,admitted to and treated in our department between June of 2016 and 2018,were included and randomized into PPH group( n= 48) and MMH group( n= 46).The two groups were compared regarding therapeutic effect and short-and long-term effects. Results :The overall effective rate was 97.9%(47/48) in the PPH group and 93.5%(43/46) in the MMH group.The operative time,intraoperative blood loss,postoperative hospital stay,pain duration and pain scoring on VAS were significantly lower in the PPH group than in the MMH group.The difference was statistically significant ( P< 0.01).Patients in PPH group had lower incidence of postoperative anal bulge( P< 0.05),yet the difference was insignificant in reoperation from postoperative bleeding,urinary retention,anal edema,anal stenosis,constipation,sensation and defecation abnormalities between the two groups ( P> 0.05). Conclusion :PPH can be clinically curative effect for mixed hemorrhoids in stage Ⅲ and stage Ⅳ besides its easy procedure,higher surgical safety and fewer postoperative complications,and is worthy of recommendation in grass-roots hospitals.