改良M-M术与PPH术治疗混合痔的近远期疗效及其成本效果分析

Short-term and long-term efficacy of modified M-M and PPH in the treatment of mixed hemorrhoids and cost-effectiveness analysis

目的探讨改良外剥内扎术(M-M)与吻合器痔上黏膜环切术(PPH)治疗混合痔的近远期疗效及其成本效果。方法回顾性分析深圳市大鹏新区葵涌人民医院外科2019年6~8月收治的120例混合痔患者的临床资料,按照手术方式不同分为A组和B组,每组60例,A组使用改良M-M术治疗,B组使用PPH术治疗。比较两组患者术后1个月的临床疗效、围术期情况、术前及术后1个月症状改善情况、术后1年复发率、近远期并发症发生率及成本效果(AC/E)。结果A组和B组患者的临床疗效总有效率分别为90.00%和91.67%,差异无统计学意义(P>0.05);A组患者术中出血量为(208.34±27.40)mL,明显多于B组的(117.72±12.11)mL,手术时间、住院天数分别为(48.91±5.94)min、(7.69±1.52)d,明显长于B组的(20.34±2.17)min、(3.84±0.50)d,住院费用为(4192.12±387.60)元,明显少于B组的(8123.06±764.04)元,差异均有统计学意义(P<0.01);两组患者术后便血、脱出、疼痛症状评分比较差异均无统计学意义(P>0.05);A组患者的1年复发率为1.67%,明显低于B组的11.67%,差异有统计学意义(P<0.05);近期并发症中,A组患者术后疼痛发生率为35.00%,明显高于B组的16.67%,肛门坠胀、腹部不适发生率分别为10.00%、3.33%,明显低于B组的25.00%、15.00%,差异均有统计学意义(P<0.05);远期并发症中,A组患者排便不净感、肛门坠胀感发生率分别为1.67%、1.67%,明显少于B组的11.67%、13.33%,差异均有统计学意义(P<0.05);A组患者的AC/E值为46.58%,明显低于B组的88.62%,差异有统计学意义(P<0.05)。结论改良M-M术与PPH术治疗混合痔患者均具有较好的疗效;改良M-M术出血量较多、术后恢复较慢,而PPH术后复发率及并发症发生率较高,各有优缺点,但改良M-M术具有更好的成本效果优势,值得推广应用。

Objective To study the short term and long-term efficacy and cost-effectiveness of modified Milligan-Morgan hemorrhoidectomy(M-M)and procedure for prolapse and hemorrhoids(PPH)in the treatment of mixed hemorrhoids,in order to provide reference for clinical treatment.Methods The clinical data of 120 patients with mixed hemorrhoids treated in Department of Surgery,Kwai Chung People's Hospital of Dapeng New District of Shenzhen from June 2019 to August 2019,were retrospectively analysis.The patients were divided into A group and B group by the different surgery,with 60 patients in each group.A group was treated with modified M-M,and B group was treated with PPH.The clinical efficacy at after operation 1 month,perioperative conditions,improvement of symptoms before and 1 month after operation,recurrence rate in one years,incidence of short-term and long-term complications and cost-effectiveness(AC/E)were compared between the two groups.Results The total effective rates in A group and B group were 90.00% and 91.67% respectively,with no statistically significant differece(P>0.05);the intraoperative blood loss in the A group was(208.34±27.40)mL,which was significantly higher than(117.72±12.11)mL in B group;the operation time and hospital stay were(48.91±5.94)min and(7.69±1.52)d,respectively,which were significantly longer than corresponding(20.34±2.17)min and(3.84±0.50)d in B group;the cost of hospitalization was(4192.12±387.60)yuan,which was significantly less than(8123.06±764.04)yuan in B group(all P<0.01).There was no significant difference in postoperative bleeding,prolapse and pain scores between the two groups patients(all P>0.05).The one year recurrence rate in A group was 1.67%,which was significantly lower than 11.67% in B group(P<0.05);among the short-term complications,the incidence of postoperative pain in A group was 35.00%,which was significantly higher than 16.67% in B group;the incidence of anal distension and abdominal discomfort were 10.00% and 3.33%,which were significantly lower than corresponding 25.00% and 15.00% in B group(all P<0.05).Among the long-term complications,the incidences of unclean defecation and anal distension in A group were 1.67%and 1.67%,respectively,which were significantly lower than corresponding 11.67% and 13.33% in B group(all P<0.05).The cost-effectiveness(AC/E)ratio in A group was 46.58%,which was significantly lower than 88.62% in B group(P<0.05).Conclusion The improved M-M operation and PPH operation have good curative effect in the treatment of mixed hemorrhoids.The improved M-M operation has more blood loss and slower postoperative recovery,while PPH has higher recurrence rate and complication rate,each with its advantages and disadvantages.However,the improved M-M operation has better cost-effectiveness advantages,which is worthy of application and promotion.