PPH术和传统外剥内扎术治疗环状痔的有效性与安全性

Efficacy and safety of PPH and traditional external stripping and internal ligation in the treatment of circular hemorrhoids

目的比较吻合器痔上黏膜环形切除术(PPH)和传统外剥内扎术治疗环状痔的有效性与安全性。方法将60例环状痔患者通过随机数字表法分为对照组(传统外剥内扎术)和观察组(PPH术),各30例。比较两组的治疗效果。结果观察组的愈合时间短于对照组(P<0.05);术后1周,两组VAS评分低于术前,且观察组低于对照组(P<0.05)。观察组肛门失禁、尿潴留、肛缘水肿发生率及并发症总发生率低于对照组,肛门坠胀发生率高于对照组(P<0.05)。术后2周,观察组的肛管最大静息压、直肠感觉阈值量、直肠最大耐受量、直肠最大顺应性及肛管舒张压低于对照组(P<0.05)。两组治疗优良率无显著差异(P>0.05)。结论传统外剥内扎术和PPH术应用于环状痔患者中均能取得较好的治疗效果,其中PPH术有利于改善肛肠动力学指标,减少术后并发症,加快愈合,减轻疼痛感,但传统外剥内扎术可降低肛门坠胀的发生率。临床医生应根据患者的实际情况和适应证合理选择术式,确保治疗效果。

Objective To compare the efficacy and safety of procedure for prolapse and hemorrhoids(PPH)and traditional external stripping and internal ligation in the treatment of circular hemorrhoids.Methods Sixty patients with circular hemorrhoids were divided into control group(traditional external stripping and internal ligation)and observation group(PPH)by random number table method,with 30 cases in each group.The therapeutic effects of the two groups were compared.Results The healing time of the observation group was shorter than that of the control group(P<0.05);at 1 week after operation,the VAS score of the two groups were lower than those before operation,and that of the observation group was lower than the control group(P<0.05).The incidences of anal incontinence,urinary retention,anal edema and total incidence of complications in the observation group were lower than those in the control group,while the incidence of anal distention was higher than that in the control group(P<0.05).At 2 week after treatment,the maximum anal resting pressure,rectal sensory threshold,rectal maximum tolerance,rectal maximum compliance and anal diastolic pressure in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the excellent and good rate of treatment between the two groups(P>0.05).Conclusion Both traditional external stripping and internal ligation and PPH can achieve good therapeutic effects in patients with circular hemorrhoids.PPH is conducive to improve anorectal motility indexes,reduce postoperative complications,accelerate healing and reduce pain.However,traditional external stripping and internal ligation can reduce the incidence of anal distension.Clinicians should reasonably select the operation method according to the actual situation and indications of patients in order to ensure the treatment effect.