改良选择性痔上黏膜吻合术联合完全肛管上皮保留术治疗环状混合痔的临床效果观察

Effect of modified tissue-selecting therapy stapler combined with complete anal epithelial retention for treating circular mixed hemorrhoids

目的观察改良选择性痔上黏膜吻合术(TST)联合完全肛管上皮保留术治疗环状混合痔的临床疗效。方法纳入2018年9月至2019年12月常熟市中医院肛肠科收治的80例环状混合痔患者为研究对象,随机分为治疗组(n=40,行改良TST术联合完全肛管上皮保留术)与对照组(n=40,行Milligan-Morgan术)。比较两组手术时间、术中出血量、肛门疼痛程度(术后当天、首次排粪及术后第一天)、术后并发症(肛缘水肿、尿潴留、术后大出血及肛门狭窄)的发生情况,术后6个月的肛门功能、疗效及满意度。结果两组手术时间、术后当天肛门VAS评分、术后肛缘水肿评分、尿潴留发生率、术后大出血发生率、肛门狭窄发生率及术后6个月的疗效比较差异均无统计学意义(均P>0.05);治疗组术中出血量少于对照组,首次排粪及术后第一天肛门VAS评分低于对照组,差异均有统计学意义(均P<0.05)。术后6个月,治疗组Wexner肛门失禁评分低于对照组,满意度高于对照组,差异均有统计学意义(均P<0.05)。结论采用改良TST术联合完全肛管上皮保留术治疗环状混合痔在减轻肛门疼痛、保护肛门功能及提高患者满意度方面有一定优势,具有临床推广价值。

Objectives To investigate the effect of modified tissue-selecting therapy stapler combined with complete anal epithe⁃lial retention for treating circular mixed hemorrhoids.Methods Eighty patients with circular mixed hemorrhoids treated at the De⁃partment of Anorectal Diseases,Changshu Traditional Chinese Medicine Hospital,were recruited between September 2018 and De⁃cember 2019.Patients were randomly assigned to the treatment group(n=40,receiving modified tissue-selecting therapy stapler combined with complete anal epithelial retention)and control group(n=40,receiving Milligan-Morgan hemorrhoidectomy).The fol⁃lowings were compared between the two groups:duration of surgery,intraoperative blood loss,anal pain using visual analogue scale(VAS)(on the day of surgery,at the first bowel movement,and one day after surgery),postoperative complications(anal edema,urinary retention,massive postoperative hemorrhage,and anal stricture),anal function at 6 months after surgery,surgery effectiveness rate,and patients’satisfaction.Results The two groups did not differ in duration of surgery,anal pain on the day of surgery,postoperative anal edema,incidence of urinary retention,massive postoperative hemorrhage,anal stricture,and effective⁃ness rate at 6 months after surgery(P>0.05).Intraoperative blood loss,as well as pain at the first bowel movement and at 1 day after surgery was significantly less in the treatment group(P<0.05).At 6 months after surgery,the Wexner incontinence score was significantly lower,and patients’satisfaction was significantly higher in the treatment group than in the control group(P<0.05).Conclusion Modified tissue-selecting therapy stapler combined with complete anal epithelial retention can relieve pain,protect anal function,and improve patients’satisfaction with circular mixed hemorrhoids.It has the potential for wider clini⁃cal application.