自动弹力线套扎术（RPH-4）联合套扎线远端高渗糖注射治疗Ⅱ～Ⅲ度混合痔的疗效观察

Effect of elastic thread ligation(RPH-4) combined with injection of hypertonic glucose solution into distal side of the ligation in treating grade Ⅱ～Ⅲ mixed hemorrhoids

目的探讨自动弹力线套扎术(RPH-4)联合套扎线远端高渗糖注射治疗Ⅱ~Ⅲ度混合痔的临床效果。方法纳入2019年1月至2019年8月广州中医药大学第一附属医院肛肠科收治的60例Ⅱ~Ⅲ度混合痔患者为研究对象,按照不同的手术方式分为观察组(n=30,采用RPH-4联合套扎线远端高渗糖注射治疗)和对照组(n=30,行单纯痔套扎术)。比较两组术后1个月的临床疗效、手术时间、住院时间、术后恢复工作时间、不同时间点(术后24 h内、术后第一次排便时及术后1周时)疼痛VAS评分及术后1个月内并发症发生情况。结果观察组共26例(87%)患者痊愈,对照组17例(57%)患者痊愈,两组治愈率比较,差异有统计学意义(P<0.05)。两组手术时间、住院时间比较,差异均无统计学意义(均P>0.05);观察组术后恢复工作时间早于对照组,差异有统计学意义(P<0.05)。两组术后24 h内、术后第一次排便时及术后1周时的疼痛VAS评分比较,差异均无统计学意义(均P>0.05)。两组均无肛门狭窄病例发生,尿潴留、伤口水肿发生率比较差异均无统计学意义(均P>0.05),肛门坠胀、术后肛门出血及并发症总发生率比较,差异均有统计学意义(均P<0.05)。结论 RPH-4联合套扎线远端高渗糖注射治疗Ⅱ~Ⅲ度混合痔疗效确切,治愈率高,并发症少,术后恢复快。

Objectives To investigate the effect of elastic thread ligation(RPH-4)combined with injection of hypertonic glu⁃cose solution into distal side of the ligation in treating gradeⅡ~Ⅲmixed hemorrhoids.Methods Sixty patients with gradeⅡ~Ⅲmixed hemorrhoids treated at Department of Anorectal Diseases,The First Affiliated Hospital of Guangzhou University of Chi⁃nese Medicine,between January and August 2019 were recruited.They were divided according to the surgery.Patients in the treatment group(n=30)received RPH-4 combined with injection of hypertonic glucose solution into distal side of the ligation.Pa⁃tients in the control group(n=30)received simple ligation.The followings were compared between the two groups:effectiveness at 1 month after surgery,duration of surgery,hospitalization,time to return to work,pain measured by Visual Analogue Scale within 24 hours,first bowel movement,and 1 week after surgery and complications.Results Twenty-six(87%)patients in the treatment group were cured compared to 17(57%)in the control group,with significant between-group difference(P<0.05).There was no significant difference in duration of surgery and hospitalization between groups(P>0.05).Time to return to work was sig⁃nificantly shorter in the treatment group than in the control group(P<0.05).Pain scores within 24 hours,first bowel movement,and 1 week after surgery did not differ significantly between groups(P>0.05).No anal stricture was observed.Incidence of uri⁃nary retention and wound edema was similar between groups(P>0.05),while incidence of anal bearing-down and anal bleeding and overall incidence of complications differed significantly between groups(P<0.05).Conclusion RPH-4 combined with injec⁃tion of hypertonic glucose solution into distal side of the ligation is effective in treating gradeⅡ~Ⅲmixed hemorrhoids with high cure rate,fewer complications,and faster postoperative recovery.