分段切断部分内括约肌联合肛门成形术治疗环状混合痔的临床疗效观察

Effect of segmental internal sphincterotomy with anoplasty for circumferential mixed hemorrhoids

目的探讨分段切断部分内括约肌联合肛门成形术治疗环状混合痔的临床效果。方法回顾性分析2015年1月至2018年12月四川省第二中医医院、成都中医药大学附属医院、成都医学院第一附属医院收治的315例行手术治疗的环状混合痔患者的临床资料,根据手术方式的不同分为观察组(n=170,行分段切断部分内括约肌联合肛门成形术)和对照组(n=145,行外剥内扎术)。比较两组手术时间、术中出血量、创面愈合时间、创面疼痛、术后并发症、肛门功能及排粪顺畅程度(CCS评分)的差异。结果两组手术时间、术中出血量、术后第1天的创面VAS疼痛评分、迟发性便血和肛门坠胀发生率比较差异均无统计学意义(均P>0.05)。观察组创面愈合时间较对照组短,术后第3天和第7天的创面VAS疼痛评分较对照组低,术后肛缘水肿、尿潴留、粪便嵌塞发生率低于对照组,差异均有统计学意义(均P<0.05)。两组术前肛门狭窄程度评分比较差异无统计学意义(P>0.05);术后2周、术后24周及术后48周,观察组的肛门狭窄程度评分均低于对照组(均P<0.05)。两组术前肛管静息压比较差异无统计学意义(P>0.05);观察组术后2周、术后24周及术后48周肛管静息压均低于对照组,差异有统计学意义(均P<0.05)。两组术前及术后2周CCS评分比较差异均无统计学意义(均P>0.05);观察组术后24周及术后48周的CCS评分低于对照组,差异均有统计学意义(均P<0.05)。结论分段切断部分内括约肌联合肛门成形术治疗环状混合痔有缩短创面愈合时间、减轻术后疼痛、减少术后并发症和保护肛门功能等优势,具有良好的临床应用价值。

Objectives To investigate the effect of segmental internal sphincterotomy with anoplasty for circumferential mixed hemorrhoids.Methods This was a retrospective analysis of 315 patients with circumferential mixed hemorrhoids who received surgery between January 2015 and December 2018 at the Second Hospital of Traditional Chinese Medicine of Sichuan Province,Chengdu University of Traditional Chinese Medicine,and the First Affiliated Hospital of Chengdu Medical College.Patients were divided into treatment group(n=170,receiving segmental internal sphincterotomy with anoplasty)and control group(n=145,receiv⁃ing Milligan-Morgan hemorrhoidectomy)according to the surgery received.The following were compared between the two groups:operation time,intraoperative blood loss,wound healing time,wound pain,postoperative complications,anal function,and Cleve⁃land Clinic Score(CCS).Results The two groups did not differ significantly in operation time,intraoperative blood loss,visual analog scale(VAS)at 1 day after surgery,and the incidence of delayed hematochezia and anal distension(P>0.05).Compared with the control group,the treatment group had significantly shorter wound healing time,lower VAS at 3 and 7 days after sur⁃gery,lower incidence of anal edema,urinary retention,and fecal impaction(P<0.05).The anal stricture severity score and resting anal pressure before surgery was similar between the two groups(P>0.05);however,the anal stricture severity score and resting anal pressure at 2,24,and 48 weeks after surgery were significantly lower in the treatment group(P<0.05).The two groups did not differ significantly in CCS before surgery and at 2 weeks after surgery(P>0.05),CCS at 24 and 48 weeks after surgery was significantly lower in the treatment group(P<0.05).Conclusion Segmental internal sphincterotomy with anoplasty has several ad⁃vantages in treating circumferential mixed hemorrhoids,including shortened wound healing time,reduced postoperative pain,re⁃duced risk of postoperative complications,and better anal function.It has potential for wider use in clinical practice.