吻合器痔上黏膜环切术联合部分肛门括约肌切断术对重度混合痔术后创缘水肿及肛门功能的影响

Effect of Stapler Hemorrhoid Excision Combined with Partial Anal Sphincterotomy on Edema of Wound Margin and Anal Function after Severe Mixed Hemorrhoids Operation

目的:观察吻合器痔上黏膜环切术(PPH)联合部分肛门括约肌切断术治疗重度混合痔对患者术后创缘水肿及肛门功能的影响。方法:回顾分析安徽皖北煤电集团总医院2019年1月至2020年11月期间收治的103例重度混合痔患者的资料,并依据术式不同将其分为联合组(PPH+切断术,n=52例)与对照组(单纯PPH术,n=51例)。观察比较治疗7d后两组临床治疗总有效率、术后创缘水肿情况以及肛门功能指标变化。结果:联合组治疗的总有效率(100%)明显高于对照组(90.20%),差异有统计学意义(χ^(2)=5.289,P<0.05);联合组患者术后创缘水肿情况明显较对照组轻,差异有统计学意义(χ^(2)=19.443,P<0.05);联合组患者术后创缘水肿评分[(2.34±1.05)分]明显低于对照组[(5.24±2.67)分],差异有统计学意义(t=7.658,P<0.05);治疗7d后,联合组患者的肛门功能指标肛管静息压以及舒张压治疗前后差值明显高于对照组,差异均有统计学意义(t=6.449、6.540,P<0.05);联合组患者术后并发症总发生率(3.85%)明显低于对照组(13.73%),差异有统计学意义(P<0.05)。结论:与吻合器痔上黏膜环切术相比,吻合器痔上黏膜环切术联合肛门括约肌切断术治疗重度混合痔,可明显提高临床疗效,缓解患者创缘水肿,同时改善患者肛门功能,降低术后并发症发生率。

Objective:To investigate the effects of surgical procedures for prolapseand oral sphincterotomy(PPH)combined with partial anal sphincterotomy for severe mixed hemorrhoids on postoperative wound edema and anal function.Methods:The data of 103 patients with severe mixed hemorrhoids admitted to the General Hospital of Anhui Wanbei Coal and Power group from January 2019 to November 2020 were retrospectively analyzed,and they were divided into the combined group(PPH+amputation,n=52)and the control group(PPH alone,n=51)according to different surgical methods.After 7 days of treatment,the total effective rate,postoperative edema and anal function of the two groups were observed and compared.Results:The total effective rate(100%)of the combination group was significantly higher than that of the control group(90.20%),and the difference was statistically significant(χ^(2)=5.289,P<0.05).The postoperative edema in the combined group was significantly lighter than that in the control group,the difference was statistically significant(χ^(2)=19.443,P<0.05).The postoperative wound edge edema score[(2.34±1.05)points]of the combined group was significantly lower than that of the control group[(5.24±2.67)points],and the difference was statistically significant(t=7.658,P<0.05).After 7 days of treatment,the difference between the anal function indicators of the anal canal resting pressure and diastolic pressure before and after treatment in the combined group was significantly higher than that of the control group,and the differences were statistically significant(t=6.449,6.540,P<0.05).The total incidence of postoperative complications in the combined group(3.85%)was significantly lower than that in the control group(13.73%),and the difference was statistically significant(P<0.05).Conclusion:Compared with stapler hemorrhoidectomy,stapler hemorrhoidectomy combined with anal sphincterotomy in the treatment of severe mixed hemorrhoids can significantly improve the clinical efficacy,alleviate the edema of the wound margin,improve the anal function and reduce the incidence of postoperative complications.