痔动脉结扎联合自动弹力线套扎术治疗老年Ⅲ度混合痔的临床效果观察

Hemorrhoid artery ligation combined with Ruiyun procedure for the treatment of grade Ⅲ mixed hemorrhoids in older patients

目的探讨痔动脉结扎联合自动弹力线套扎术治疗老年Ⅲ度混合痔的临床疗效。方法将2019年1月至2019年11月上海市长宁区天山中医医院肛肠科收治的96例老年Ⅲ度混合痔患者依据入院顺序逐次分为对照组与研究组,对照组(n=48)接受胶圈套扎术,研究组(n=48)接受痔动脉结扎联合自动弹力线套扎术。比较两组术后并发症、术后疗效,以及手术前后肛管直肠压力指标与Wexner便秘评分量表评分。结果术后1周,研究组术后出血、水肿、尿潴留、创面渗出严重程度均轻于对照组(均P<0.05)。术后1个月,研究组治疗总有效率高于对照组(P<0.05)。术前,两组所检测的肛管直肠压力指标比较差异均无统计学意义(均P>0.05),其中对照组与研究组直肠肛门抑制反射阳性例数分别为47例、46例;术后半年,两组直肠静息压、肛管静息压、肛管最大收缩压低于组内术前,肛管高压带长度短于组内术前(均P<0.05),对照组与研究组直肠肛门抑制反射阳性例数分别为30例、42例;研究组肛管静息压、肛管最大收缩压、直肠肛门抑制反射阳性率高于对照组,肛管高压带长度长于对照组(均P<0.05);两组直肠静息压比较差异无统计学意义(P>0.05)。术前,两组Wexner便秘评分比较,差异无统计学意义(P>0.05);术后半年,两组该评分低于组内术前,研究组评分低于对照组(均P<0.05)。结论痔动脉结扎联合自动弹力线套扎术治疗老年Ⅲ度混合痔疗效确切,可较好保护肛门功能,缓解便秘,减轻术后并发症的严重程度。

Objectives To investigate the effect of combining hemorrhoid artery ligation and Ruiyun procedure for hemorrhoids(RPH)for the treatment of gradeⅢmixed hemorrhoids in older patients.Methods Ninety-six older patients with gradeⅢmixed hemorrhoids treated at the Department of Anorectal Diseases,Shanghai Changning Tianshan Traditional Chinese Medicine Hospital,between January and November 2019 were recruited.Patients were assigned to the control group and the treatment group according to their admission order.Patients in the control group(n=48)received rubber band ligation,and patients in the treatment group(n=48)received a combination of hemorrhoid artery ligation and RPH.Incidence of postoperative complications,efficacy,anorectal manometry index and Wexner Constipation Scoring System before and after surgery were compared between the two groups.Results One week after surgery,the control group had more severe bleeding,edema,urinary retention,and incision oozing than the treatment group(P<0.05).One month after surgery,overall efficacy was significantly better in the treatment group(P<0.05).The anorectal manometry indices before surgery were similar between the two groups(P>0.05).The positive rectal anal inhibitory reflex(RAIR)in the control group and the treatment group were 47 and 46 cases,respectively.Six months after surgery,rectal resting pressure,anal resting pressure,and anal maximum squeeze pressure decreased,and the high pressure anal zone length shortened in both groups(P<0.05).The positive RAIR in the control group and the treatment group were 30 and 42 cases,respectively.The treatment group had significantly higher anal resting pressure,anal maximum squeezing pressure,rate of positive RAIR,and longer high pressure anal zone length than the control group(P<0.05).The rectal resting pressure was comparable between the two groups(P>0.05).The Wexner Constipation Score before surgery was similar between the two groups(P>0.05).Six months after surgery,Wexner Constipation Score decreased in both groups,with a significantly lower score in the treatment group(P<0.05).Conclusion Combination of hemorrhoid artery ligation and RPH for older patients with gradeⅢmixed hemorrhoids was effective.It could protect patients’anal function as well as alleviate constipation and the severity of complications.