选择性痔上黏膜切除吻合术微创手术治疗混合痔前后肛管测压的研究

Anal manometry before and after TST minimally invasive surgery for mixed hemorrhoids

目的分析对混合痔使用选择性痔上黏膜切除吻合术(TST)微创治疗, 对患者手术前后肛管测压水平的影响。方法随机选取2020年3月至2021年1月我院收治86例混合痔患者, 根据患者病床号分组、各43例, 对照组患者接受外切内扎术治疗, 研究组患者行TST微创手术治疗, 比较两组患者治疗效果、手术前后肛肠动力学改变、术后症状评分、肛门平整度与狭窄度等。通过t检验及计数资料经χ2检验进行分析对比。结果研究组治愈率69.77%、显著高于对照组48.84%, 差异有统计学意义(P<0.05)。术后3个月, 两组患者直肠耐受量、直肠感觉阈值、肛管直肠压力差、肛管静息压等均显著性下降, 与术前比较(P<0.05);而对照组术后3个月直肠静息压升高为(17.33±2.40) mmHg(1 mmHg=0.133 kPa), 研究组则呈下降趋势(10.37±1.20) mmHg, 与术前比较(P<0.05)。术后3个月两组间指标比较, 研究组直肠耐受量、直肠感觉阈值、直肠静息压均低于对照组, 而肛管直肠压力差、肛管静息压高于对照组(P<0.05)。两组术后肛门平整度比较, 研究组患者不平整总计占2.33%显著低于对照组20.93%(P<0.05), 术后3、7 d研究组患者肛门坠胀、肛缘水肿、创面疼痛等症状评分均显著低于对照组(P<0.05);术后7 d研究组患者便时出血症状评分低于对照组(P<0.05)。结论对于混合痔采用TST微创手术与外切内扎术比较, 前者手术治疗效果更具优势, 且对于患者术后肛肠动力学影响更小, 患者术后肛门更平整, 同时患者术后恢复快速, 症状更为轻微, 值得推广。

Objective To analyze the effect of selective suprahemorrhoidectomy and anastomosis(TST)on anal manometry in patients with mixed hemorrhoids.Methods Totally,86 patients with mixed hemorrhoids in our hospital from March 2020 to January 2021 were randomly selected,and they were divided into two groups according to the bed number of patients,43 cases in each group.The control group was treated with external resection and internal ligation,and the study group was treated with TST minimally invasive surgery.The curative effectiveness,anorectal dynamic changes before and after surgery,postoperative symptom score,anal flatness and stenosis were compared between the two groups using SPSS 21.0 t test and χ^(2) test for counting data.Results The cure rate of the study group was 69.77%,significantly higher than 48.84%of the control group(P<0.05).At 3rd month after operation,the rectal tolerance,rectal sensory threshold,anal workplace pressure difference and anal resting pressure in the two groups were significantly decreased as compared with those before operation(P<0.05).The rectal resting pressure in the control group[(17.33±2.40)mmHg(1 mmHg=0.133 kPa)]increased at 3rd month after operation,and that in the study group[(10.37±1.20)mmHg]showed a downward trend,compared with that before operation(P<0.05).At 3rd month after operation,the rectal tolerance,rectal sensory threshold and rectal resting pressure in the study group were lower than those in the control group,and anorectal pressure difference and anal resting pressure in the study group were higher than those in the control group(P<0.05).Compared with the control group(20.93%),the anal flatness in the study group(2.33%)was significantly reduced(P<0.05).The anal swelling,anal edema,wound pain and other symptom scores in the study group were significantly lower than those in the control group on the 3rd and 7th d after operation(P<0.05).On the 7th day after operation,the symptom score of bleeding during defecation in the study group was lower than that in the control group(P<0.05).Conclusion For mixed hemorrhoids,TST minimally invasive surgery has more advantages than external resection and internal ligation,and has less impact on anorectal dynamics,smoother anus,faster recovery and milder symptoms,which is worthy of promotion.