悬吊黏膜下痔切除术治疗环状混合痔的临床观察

Clinical observation on lift-up submucosal hemorrhoidectomy in the treatment of annular mixed hemorrhoids

目的:比较悬吊黏膜下痔切除术与传统外剥内扎术治疗环状混合痔的临床疗效。方法:纳入90例环状混合痔患者,随机分为治疗组与对照组,每组各45例。治疗组患者采用悬吊黏膜下痔切除术治疗,对照组患者采用外剥内扎术治疗。术后3个月,评价并比较两组患者的临床疗效;术后第1、3、7、14天,评价所有患者的肛门疼痛、出血、创面水肿、肛门坠胀感、排便情况评分;术后3个月,采用Wexner量表评估患者的肛门功能,检测患者的肛管直肠压力,包括直肠静息压、肛管静息压、肛管最大收缩压;比较两组患者的手术时间、住院时间、创面愈合时间及住院费用。结果:(1)术后3个月,两组患者的临床总有效率均为100%,组间比较差异无统计学意义(P>0.05)。(2)术后第1、3、7、14天,治疗组患者的肛门疼痛评分均低于对照组(P<0.05,P<0.01);术后第1、3、7天,治疗组患者的出血、肛门坠胀感评分均低于对照组(P<0.05,P<0.01);术后第3天,治疗组患者的创面水肿评分亦低于对照组(P<0.05)。(3)术后3个月,治疗组患者的肛管静息压明显低于对照组(P<0.01)。(4)治疗组患者的手术时间、住院时间、创面愈合时间较对照组均明显缩短(P<0.01),住院费用较对照组明显减少(P<0.01)。结论:与外剥内扎术相比,悬吊黏膜下痔切除术治疗环状混合痔具有较好的临床疗效,能够有效减轻患者术后疼痛、出血、创面水肿、肛门坠胀等症状,有助于恢复肛门功能,且具有较好的经济性。

Objective:To compare the clinical efficacy between lift-up submucosal hemorrhoidectomy and traditional Milligan-Morgan hemorrhoidectomy in the treatment of annular mixed hemorrhoids.Methods:A total of 90 patients with annular mixed hemorrhoids were included and randomly divided into the treatment group and control group,45 cases in each group.The patients in the treatment group were treated with therapy of lift-up submucosal hemorrhoidectomy,and the patients in the control group were treated with therapy of Milligan-Morgan hemorrhoidectomy.Three months after operation,the clinical efficacy of the two groups were evaluated and compared.On the 1 st,3 rd,7 th and 14 th days after operation,the scores of anal pain,bleeding,wound edema,anal distension and defecation were evaluated.Three months after operation,the Wexner scale was applied to evaluate the anal function,and the indexes of anorectal pressure including rectal resting pressure,anal resting pressure and maximal anal contraction pressure were detected.The operation time,hospitalization time,wound healing time and hospitalization cost of the two groups were compared.Results:(1)Three months after operation,the clinical total effective rates of the two groups were 100%,with no statistically significant difference between the two groups(P>0.05).(2)On the 1 st,3 rd,7 th and 14 th days after operation,the score of anal pain in the treatment group was lower than that in the control group(P<0.05,P<0.01).On the 1 st,3 rd and 7 th days after operation,the scores of bleeding and anal distension in the treatment group were lower than those in the control group(P<0.05,P<0.01).On the 3 rd day after operation,the score of wound edema in the treatment group was also lower than that in the control group(P<0.05).(3)Three months after operation,the anal resting pressure in the treatment group was significantly lower than that in the control group(P<0.01).(4)The operation time,hospitalization time and wound healing time in the treatment group were significantly shorter than those in the control group(P<0.01),and the hospitalization cost was significantly less than that in the control group(P<0.01).Conclusion:Compared with Milligan-Morgan hemorrhoidectomy,lift-up submucosal hemorrhoidectomy shows good clinical efficacy in the treatment of annular mixed hemorrhoids,and can effectively alleviate the symptoms such as postoperative pain,bleeding,wound edema and anal distension,and restore the anal function,with good economy.