痔体半切除联合消痔灵注射治疗环状混合痔的疗效观察

Efficacy of partial hemorrhoidectomy with Xiaozhiling injection in treatment of circular mixed hemorrhoids

目的观察痔体半切除联合消痔灵注射治疗环状混合痔的临床疗效。方法选取2016年1月至2019年6月浙江省人民医院收治的400例环状混合痔患者为研究对象,按随机数字表法分为观察组(痔体半切除联合消痔灵注射)和对照组(外剥内扎术),每组200例。观察并比较两组患者术后近期并发症(肛门疼痛、肛缘水肿、尿潴留、继发大出血等)、创面愈合时间、住院时间及术后随访12周的临床疗效、肛肠动力学指标、远期并发症(残留痔、肛门狭窄、肛门溢液)等情况。结果两组患者术后均无严重并发症发生。观察组患者术后1、3、5、7 d肛门疼痛及肛缘水肿评分均低于对照组(均P<0.05),而术后14 d两组患者上述评分比较差异均无统计学意义(均P>0.05)。观察组患者术后尿潴留发生率明显低于对照组(P<0.05),而继发大出血发生率比较差异无统计学意义(P>0.05)。观察组创面愈合时间、住院时间均明显短于对照组(均P<0.05)。两组患者术前肛管静息压、肛管最大收缩压及术后12周肛管最大收缩压比较,差异均无统计学意义(均P>0.05);术后12周观察组肛管静息压高于对照组(P<0.05);观察组及对照组患者术后12周肛管静息压均低于术前(均P<0.05),肛管最大收缩压手术前后比较差异均无统计学意义(均P>0.05)。观察组患者术后12周临床疗效明显优于对照组(P<0.05)。观察组出现残留痔的比例明显低于对照组(P<0.05),肛门狭窄情况好于对照组(P<0.05),两组患者均无肛门溢液。结论痔体半切除联合消痔灵注射治疗环状混合痔疗效确切,患者术后疼痛轻,创面愈合快,并发症发生率低,值得在临床推广应用。

Objective To assess the efficacy of partial hemorrhoidectomy combined with injection of Xiaozhiling in treatment of circular mixed hemorrhoids.Methods Four hundred patients with circular mixed hemorrhoids were randomly divided into study group(partial hemorrhoidectomy with Xiaozhiling injection)and control group(Milligan-Morgan surgery).The postoperative pain,urine retention,secondary bleeding and anal edema were observed within 2 weeks after operation.The postoperative hospitalization time,wound healing time was documented.Clinical efficacy and anal pressure measurement were evaluated 12 weeks after operation.Results There were no serious postoperative complications in the two groups.The pain and anal edema in the study group were better than those in the control group 1,3,5 and 7 days after operation(P<0.05).The incidence of postoperative urinary retention was less than that in the control group(P<0.05).The incidence of postoperative bleeding was similar to the control group(P>0.05).The hospitalization time and healing time of the study group were significantly shorter than those of the control group(P<0.05).There was no significant difference in resting anal sphincter pressure,maximal anal squeeze pressure before operation and anal maximum systolic pressure 12 weeks after operation between the two groups(P>0.05).The resting anal sphincter pressure in the study group was higher than that in the control group at 12 weeks after operation(P<0.05).The resting anal sphincter pressure in the treatment group and the control group 12 weeks after operation was lower than that before operation(P<0.05).The evaluation 12 weeks after operation showed that the clinical efficacy of study group was better than that of the control group(P<0.05).Conclusion Partial hemorrhoidectomy combined with Xiaozhiling injection is an ideal method for the treatment of circular mixed hemorrhoids.The postoperative pain is light,the wound healing is fast,and the incidence of complications is low,which is worthy of clinical application.