PPH联合部分肛门内括约肌切断术治疗重度混合痔的远期疗效及安全性

Long-term efficacy and safety of PPH combined with partial internal anal sphincterotomy on severe mixed hemorrhoids

目的探讨吻合器痔上黏膜环切除术(PPH)联合部分肛门内括约肌切断术治疗重度混合痔的远期疗效及安全性。方法抽取2018年1月至2020年1月中铁十七局集团有限公司中心医院收治的初治重度混合痔患者88例,依据手术方案将其分为两组。对照组44例采取PPH治疗,观察组44例在PPH治疗基础上联合应用肛门内括约肌切断术治疗。回顾性对照分析两组患者围术期指标、术后并发症及复发情况。结果观察组手术时间长于对照组(t=7.337,P<0.05),术后疼痛视觉模拟评分低于对照组(t=8.382,P<0.05)。两组患者创面愈合、住院时间、出血量、并发症发生率比较,差异未见统计学意义(P>0.05)。随访6~24个月,观察组术后复发指标如痔核脱出、便血、肛门疼痛发生率为2.27%(1/44)、4.55%(2/44)、4.55%(2/44),低于对照组的20.45%(9/44)、29.55%(13/44)、22.73%(10/44),P<0.05。结论PPH联合部分肛门内括约肌切断术治疗重度混合痔不增加术中出血量、术后并发症,术后疼痛较轻,远期疗效及安全性较好。

Objective To analyze long-term efficacy and safety of procedure for prolapse and hemorrhoid(PPH)combined with partial internal anal sphincterotomy on patients with severe mixed hemorrhoids.Methods A total of 88 newly-treated patients with severe mixed hemorrhoids admitted to the Central Hospital of China Railway 17th Bureau Group from January 2018 to January 2020 were divided into two groups according to the surgical plan.Forty-four patients in the control group were treated with PPH,and 44 patients in the observation group was treated with PPH combined with internal anal sphincterotomy.The perioperative indicators,postoperative complications and recurrence of the two groups of patients were analyzed retrospectively.Results The operation time in the observation group was longer than that in the control group(t=7.337,P<0.05),and the visual analogue score of postoperative pain was lower than that in the control group(t=8.382,P<0.05).There were no significant differences in wound healing,hospitalization time,bleeding volume,and complication rate between the two groups(P>0.05).Followed up for 6 to 24 months,the recurrence indicators such as the incidence of postoperative hemorrhoids,blood in the stool,and anal pain in the observation group were 2.27%(1/44),4.55%(2/44),4.55%(2/44),which lower than 20.45%(9/44),29.55%(13/44),22.73%(10/44)in the control group,P<0.05.Conclusions PPH combined with partial internal anal sphincterotomy for severe mixed hemorrhoids does not increase intraoperative blood loss,postoperative complications,postoperative pain is less,and the long-term efficacy and safety are better.