横分纵扎术与外剥内扎术治疗内痔为Ⅲ~Ⅳ度的环状痔疗效与安全性比较

Comparison of the efficacy and safety of transverse division with longitudinal liga⁃tion and Milligan-Morgan hemorrhoidectomy for treating circumferential mixed hemorrhoids with gradeⅢ~Ⅳinternal hemorrhoids

目的比较横分纵扎术与外剥内扎术治疗内痔为Ⅲ~Ⅳ度的环状痔疗效及安全性。方法将2019年3月至2019年9月在中日友好医院肛肠科住院的60例环状痔(内痔为Ⅲ~Ⅳ度)患者随机分为治疗组与对照组,每组各30例。治疗组采取横分纵扎术,对照组采用外剥内扎术。比较两组的疗效及安全性。结果两组的总有效率均为100%,治愈率比较差异无统计学意义(P>0.05)。切口愈合时间比较差异无统计学意义(P>0.05)。术后第30天,治疗组术后残余外痔覆盖点位数少于对照组(P<0.05)。术后第1天,两组VAS评分比较差异无统计学意义(P>0.05),术后第3、7天,治疗组VAS评分均低于对照组(均P<0.05)。两组均未出现较大量的出血事件,尿潴留及肛门狭窄发生率比较差异均无统计学意义(均P>0.05),治疗组创缘水肿发生率低于对照组(P<0.05)。结论横分纵扎术治疗内痔为Ⅲ~Ⅳ度的环状痔疗效确切,安全性良好,在减轻术后疼痛、创缘水肿及减少外痔残留方面相比外剥内扎术有一定的应用优势。

Objectives To compare the efficacy and safety of transverse division with longitudinal ligation and Milligan-Morgan hemorrhoidectomy for treating circumferential mixed hemorrhoids with grade Ⅲ~Ⅳ internal hemorrhoids.Methods Sixty patients with circumferential mixed hemorrhoids(grade Ⅲ~Ⅳ internal hemorrhoids) treated at the China-Japan Friendship Hospital between March 2019 and September 2019 were randomly assigned to the treatment group and control group with 30 patients in each group.Patients in the treatment group received transverse division with longitudinal ligation,and those in the control group received Milligan-Morgan hemorrhoidectomy.Efficacy and safety were compared between the two groups.Results The total response rate was all 100%,and the cure rate was comparable between the two groups(P>0.05).Time to wound healing was similar between the two groups(P>0.05).At the thirtieth day after surgery,there were fewer residual external hemorrhoids in the treatment group than in the control group(P<0.05).Pain visual analog scale at the first day after surgery was similar between the two groups(P>0.05).However,it was significantly lower in the treatment group at the third and the seventh days after surgery(P<0.05).No massive haemorrhage occurred,and the two groups did not differ in the incidence of urinary retention and anal stricture(P>0.05).The incidence of wound edema was significantly lower in the treatment group(P<0.05).Conclusion Transverse division with longitudinal ligation was effective in treating circumferential mixed hemorrhoids with grade Ⅲ~Ⅳ internal hemorrhoids.It was a safe procedure and had the advantage over Milligan-Morgan hemorrhoidectomy in lowering postoperative pain and wound edema as well as reducing residual external hemorrhoids.