痔动脉结扎肛垫悬吊外剥术治疗Ⅲ~Ⅳ度混合痔的多中心随机对照研究

Milligan-Morgan hemorrhoidectomy with hemorrhoidal artery ligation and anal cushion suspension for grades Ⅲ~Ⅳ mixed hemorrhoids: a multi-center randomized controlled trial

目的观察痔动脉结扎肛垫悬吊外剥术治疗Ⅲ~Ⅳ度混合痔的临床疗效。方法纳入2016年12月至2018年4月上海市长宁天山中医医院、上海中医药大学附属龙华医院、上海市嘉定区中医医院肛肠科收治的120例Ⅲ~Ⅳ度混合痔患者为研究对象。随机分为治疗组(n=60,采用痔动脉结扎肛垫悬吊外剥术)和对照组(n=60,采用外剥内扎术)。观察记录两组术后不同时间点临床症状积分(分别于术后8 h、术后24 h、术后第7、14天观察并记录患者疼痛积分、发热积分;于术后24 h、术后第7、14天观察并记录患者肛缘或皮桥水肿评分、便血评分;于术后8 h观察并记录患者尿潴留积分、创面渗出积分)、治愈时间、住院时间、治疗费用、肛门功能、疗效及复发情况。结果术后8 h,治疗组疼痛积分、发热积分、尿潴留积分、创面渗出积分均优于对照组(均P<0.05);术后24 h,治疗组疼痛积分、肛缘或皮桥水肿积分、便血积分均优于对照组(均P<0.05);术后第7天疼痛积分、肛缘或皮桥水肿积分均优于对照组(均P<0.05);术后第14天治疗组便血积分优于对照组(P<0.05)。治疗组创面愈合时间及住院时间均短于对照组,治疗费用少于对照组(均P<0.05)。术前、创面愈合后6个月、创面愈合后1年,两组肛门功能评分比较差异均无统计学意义(均P>0.05);创面愈合时,治疗组肛门功能评分优于对照组(P<0.05)。两组有效率均为100%。经1年电话随访,两组患者均无痔核复脱出及频繁出血症状发生。结论经痔动脉结扎肛垫悬吊外剥术治疗Ⅲ~Ⅳ度混合痔疗效确切,具有疼痛轻、并发症少,安全性高的特点,值得临床推广应用。

Objectives To investigate the effect of Milligan-Morgan hemorrhoidectomy with hemorrhoidal artery ligation and anal cushion suspensionfor gradesⅢ~Ⅳmixed hemorrhoids.Methods One hundred and twenty patients with gradesⅢ~Ⅳmixed hemorrhoids admitted to Departments of Anorectal Diseases at Tianshan Chinese Medicine Hospital of Changning District,Longhua Hospital of Shanghai University of Traditional Chinese Medicine,and Chinese Medicine Hospital of Jiading District in Shanghai between December 2016 and April 2018 were included in this study.Patients were randomly assigned to the treatment group and the control group,with 60 patients in each group.Patients in the treatment group received Milligan-Morgan hemor?rhoidectomy with hemorrhoidal artery ligation and anal cushion suspension,and those in the control group received Milligan-Mor?gan hemorrhoidectomy.The followings were recorded:pain and fever scores at 8 hours,24 hours,7 days,and 14 days after sur?gery,scores of perianal or dermal bridge edema and the score of hematochezia at 24 hours,7 days,and 14 days after surgery,scores of urinary retention and wound oozing at 8 hours post-surgery,time to cure,duration of hospitalization,treatment expens?es,anal function,effectiveness,and recurrence.Results At 8 hours post-surgery,scores of pain,fever,urinary retention,and wound oozing were significantly better in the treatment group than in the control group(P<0.05).At 24 hours after surgery,scores of pain,perianal or dermal bridge edema,and hematochezia were significantly better in the treatment group(P<0.05).At 7 days after surgery,scores of pain and perianal or dermal bridge edema were significantly better in the treatment group(P<0.05).At 14 days after surgery,the score of hematochezia was significantly better in the treatment group(P<0.05).The treatment group had a significantly shorter time to cure and duration of hospitalization as well as less treatment expense(P<0.05).Scores of anal function did not differ between the two groups before surgery as well as 6 months and 1 year after wounds were healed(P>0.05),but was significantly better in the treatment group when wounds were healed(P<0.05).Effectiveness was 100%in both groups.Telephone follow-up was performed at 1 year after surgery.No patient reported recurrent prolapse or frequent bleed?ing.Conclusion Milligan-Morgan hemorrhoidectomy with hemorrhoidal artery ligation and anal cushion suspension is effective for gradeⅢ~Ⅳmixed hemorrhoids.It is associated with less pain,fewer complications,and better safety.It has potential in more extensive clinical use.