RPH-4和PPH治疗Ⅲ、Ⅳ期混合痔合并直肠前突的效果比较

Comparison of Efficacy of RPH-4 and PPH in the Treatment of StageⅢandⅣMixed Hemorrhoids with Rectal Protrusion

目的:比较自动弹力线痔疮套扎器(RPH-4)和吻合器痔上黏膜环切术(PPH)治疗Ⅲ、Ⅳ期混合痔合并直肠前突的效果。方法:回顾性分析2019年3月-2021年4月于东莞市樟木头医院治疗的55例Ⅲ、Ⅳ期混合痔合并直肠前突女性患者临床资料,按照手术方式的不同将其分为RPH-4组(n=30)和PPH组(n=25)。RPH-4组采用RPH-4治疗,PPH组采用PPH治疗。比较两组临床疗效、围术期指标、排便梗阻症状(ODS)评分及并发症发生情况。结果:两组总有效率比较,差异无统计学意义(P>0.05)。RPH-4组术中出血量为(8.72±1.59)ml,少于PPH组,住院时间(5.87±1.92)d,短于PPH组,差异均有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05)。RPH-4组术后12、24 h的视觉模拟评分法(VAS)评分分别为(1.53±0.49)、(1.19±0.42)分,均低于PPH组,差异均有统计学意义(P<0.05)。术前和术后1个月,两组排便梗阻症状评分比较,差异均无统计学意义(P>0.05)。两组术后1个月时排便梗阻症状评分均低于术前,差异均有统计学意义(P<0.05)。RPH-4组并发症总发生率为3.33%,低于PPH组,差异有统计学意义(P<0.05)。结论:RPH-4治疗Ⅲ、Ⅳ期混合痔合并直肠前突能够取得与PPH相当的疗效,但RPH-4治疗并发症少、疼痛轻微,临床应用安全、有效。

Objective:To compare the efficacy of ruiyun procedure for hemorrhoids(RPH-4)and procedure for prolapse and hemorrhoids(PPH)in the treatment of stageⅢandⅣmixed hemorrhoids with rectal protrusion.Method:The clinical data of 55 female patients with stageⅢandⅣmixed hemorrhoids with rectal protrusion who were treated in Dongguan Zhangmutou Hospital from March 2019 to April 2021 were retrospectively analyzed.According to different surgical methods,they were divided into RPH-4 group(n=30)and PPH group(n=25).RPH-4 group was treated with RPH-4,PPH group was treated with PPH.Clinical efficacy,perioperative indexes,ODS scores and incidence of complications were compared between two groups.Result:There was no significant difference in the total effective rate between two groups(P>0.05).The intraoperative blood loss in the RPH-4 group was(8.72±1.59)ml,which was less than that in the PPH group,and the length of hospital stay in the RPH-4 group was(5.87±1.92)d,which was shorter than that in the PPH group,the differences were statistically significant(P<0.05).There was no significant difference in surgical time between two groups(P>0.05).The visual analog scale(VAS)scores in the RPH-4 group were(1.53±0.49)points and(1.19±0.42)points at 12 and 24 h after surgery,respectively,which were lower than those in the PPH group,the differences were statistically significant(P<0.05).There were no significant differences in the scores of bowel obstruction symptoms between two groups before and 1 month after surgery(P>0.05).The scores of bowel obstruction symptoms in both groups at 1 month after surgery were lower than those before surgery,the differences were statistically significant(P<0.05).The total incidence of complications in the RPH-4 group was 3.33%,which was lower than that in the PPH group,the difference was statistically significant(P<0.05).Conclusion:RPH-4 in the treatment of stageⅢandⅣmixed hemorrhoids with rectal protrusion can achieve the same efficacy as PPH,but RPH-4 in the treatment of fewer complications,mild pain,clinical application is safe and effective.