自动弹力线套扎术在治疗肛瘘合并混合痔中的临床研究

Clinical study of RPH in thread-elastic ligation in the combination of anal fistula and hemorrhoid

目的探讨自动弹力线套扎术(RPH)在治疗肛瘘合并混合痔的临床效果。方法选取2015年9月-2019年9月在萍乡市人民医院肛肠科住院的110例低位单纯性肛瘘合并混合痔患者,随机分为两组,治疗组60例患者采用肛瘘切除术+自动弹力线套扎术治疗,对照组50例患者采用肛瘘切除术+混合痔外剥内扎术治疗,比较两组的疗效、手术时间、创面愈合时间、术后24 h疼痛评分、术后首次排便疼痛评分及持续时间、术后并发症以及术后1年复发情况。结果治疗组治愈率(88.33%,53/60)高于对照组(82%,41/50),差异无统计学意义(χ^2=0.88,P=0.348),治疗组手术时间、创面愈合时间、术后24 h疼痛评分、术后首次排便疼痛评分及持续时间明显短于对照组,差异有统计学意义(P<0.05);治疗组术后并发症(出血、水肿)、术后1年复发的发生率明显低于对照组,差异具有统计学意义(P<0.05);治疗组的肛门狭窄发生率(3.33%,2/60)低于对照组(8%,4/50),但差异无统计学意义(χ^2=1.152,P>0.05)。结论自动弹力线套扎术在肛瘘合并混合痔的患者中疗效肯定,恢复时间短,术后并发症少,值得进行临床推广。

Objective To explore the clinical effect of RPH in thread-elastic ligation in the treatment of anal fistula combined with hemorrhoid.Methods 110 patients with internal low simple anal fistula complicated with hemorrhoid in Department of Anorectal,Pingxiang People's Hospital from September 2015 to September 2019 were randomly divided into two groups.60 patients in the treatment group were adopted low anal fistula resection plus RPH in thread-elastic ligation and 50 patients in the control group were adopted low anal fistula resection plus mixed hemorrhoid excision.The clinical efficacy、surgical time、wound healing time、pain scores of 24 hours after surgery、pain scores and duration of the first cacation after surgery,postoperative complications and recurrence of hemorrhoid 1 years after operation of the two groups were compared.Results The cure rate of the treatment group(88.33%,53/60)were higher than the control group(82%,41/50),the difference was not statistically significant(χ^2=0.88,P=0.348);The surgical time、wound healing time、pain scores of 24 hours after surgery、pain scores and duration of the first cacation after surgery had reduced significantly than the control group,the difference was statistically significant(P<0.05);Compared with the control group,the incidence of postoperative complications(haemorrhage、dropsy hydroncus)and the recurrence of hemorrhoid 1 years after operation in the treatment group was lower,the difference was statistically significant(P<0.05);The stricture of anus of the treatment group(3.33%,2/60)were lower incidence than the control group(8%,4/50),the difference was not statistically significant(χ^2=1.152,P>0.05).Conclusion The RPH in thread-elastic ligation in the treatment of anal fistula combined with hemorrhoid is effective and worthy of clinical application.