痔动脉结扎肛垫悬吊外剥术与Milligan-Morgan术对痔上动脉分支及血流速度影响的临床研究

The effect of ligation of hemorrhoid artery and Milligan-Morgan operation on the branches and blood flow velocity of superior hemorrhoid artery

目的通过不同手术方式对混合痔患者手术前后痔上动脉分支数量、分布及平均血流速度的观察,了解超声介入痔血管学研究的价值。方法80例Ⅲ~Ⅳ期混合痔患者随机分为两组,实验组采用痔动脉结扎肛垫悬吊术,对照组采用内扎外剥手术(Milligan-Morgan术)。运用肛周高频彩色多普勒检测各病例术前、愈合时痔上动脉分支数量、部位及平均血流速度变化情况,了解疗效与痔核血供变化是否存在关联。结果实验组与对照组痔动脉分支数量术前与愈合时比较,差异均有统计学意义(Z=-10.042,-7.488;P<0.05)。两组患者愈合时痔动脉分支数量差异存在统计学意义(Z=-3.500,P<0.05)。实验组术前与愈合时比较,血流速度差异存在统计学意义(t=4.086,P<0.05),且术前血流速度明显高于愈合时,而对照组的术前、愈合时血流速度比较差异无统计学意义(t=1.385,P>0.05)。两组病例术前痔动脉分布点位均以3、7、11点为主,愈合时,实验组病例痔动脉分布点位以3、5、7、9点为主,对照组病例痔动脉分布点位仍以3、7、11点为主,两组治愈率均为100%;实验组愈合时间优于对照组(t=-3.246,P<0.05)。结论超声引导下的痔动脉结扎肛垫悬吊术确实能精准结扎痔动脉,改变了痔动脉分支数量及血流速度,对出血痔有显著疗效,且具有愈合时间短的潜在优势。

Objective To observe the number,distribution and mean blood flow velocity of superior hemorrhoid artery branches before and after operation in patients with mixed hemorrhoids.Methods Eighty cases with mixed hemorrhoids of StageⅢ~Ⅳwere randomly divided into two groups.The experimental group was treated with ligation of hemorrhoid artery and anal pad suspension,while the control group was treated with Milligan-Morgan procedure,the number,location and average blood flow velocity of the superior hemorrhoid artery were measured by high-frequency color doppler ultrasound before and after operation.Results The experimental group and control group hemorrhoid artery branch number of preoperative compared with heals all differences,two groups have statistical significance(Z=-10.042,-7.488;P<0.05)when patients heal hemorrhoid artery branch number differences statistically significant(Z=-3.500,P<0.05),the blood flow velocity of the experimental group was significantly higher than that of the healing group(t=4.086,P<0.05),there was no significant difference in blood flow velocity between the control group and the control group(t=1.385,P>0.05);Preoperative hemorrhoid artery distribution points were mainly 3,7 and 11 points in both groups.When healing,the hemorrhoid artery distribution points in the experimental group were mainly 3,5,7 and 9 points,while the hemorrhoid artery distribution points in the control group were still mainly 3,7 and 11 points.The cure rate of both groups was 100%,the healing time of the experimental group was better than that of the control group(t=-3.246,P<0.05).Conclusion Ultrasound guided hemorrhoid artery ligation anal cushion suspension can really precise hemorrhoid ligation of artery,changed the hemorrhoid artery branch number and blood flow velocity,has significant curative effect on bleeding hemorrhoids,and a short healing time of potential advantages,main point of the distribution of artery change if there is a correlation with the prognosis,is worth further research.