SC-TST与PPH治疗环状痔的临床效果对比分析研究

Comparison study of SC-TST and PPH in the treatment of circumferential mixed hemorrhoids

目的对比分析错层大“C”形选择性痔上黏膜切除术(SC-TST)和痔上黏膜环切钉合术(PPH)治疗环状痔的临床效果。方法回顾性分析2017年12月至2021年1月青岛阜外心血管病医院外科和青岛市第三人民医院肛肠外科收治的148例环状痔患者的临床资料,根据手术方式的不同分为观察组(n=74,采用SC-TST治疗)和对照组(n=74,采用PPH治疗)。比较两组临床疗效、手术相关指标(手术时间、术中出血量、住院时间及住院费用)及术后并发症(术后2周肛门坠胀感、再出血,术后3个月直肠肛门狭窄、吻合钉残留)及复发情况。结果两组总有效率均为100%。两组临床疗效比较差异无统计学意义(P>0.05)。观察组的手术时间长于对照组,住院费用高于对照组(均P<0.05);两组术中出血量、住院时间比较差异均无统计学意义(均P>0.05)。两组术后5个月均无复发病例。两组术后2周肛门坠胀感、再出血的发生率比较差异均无统计学意义(均P>0.05);观察组术后3个月直肠肛门狭窄、吻合钉残留的发生率均低于对照组(均P<0.05)。结论与PPH相比,SC-TST治疗环状痔的临床疗效相当,在不增加术后肛门坠胀感、再出血的发生率的同时,可有效降低术后直肠肛门狭窄、吻合钉残留的发生率和减少复发,但手术时间延长、住院费用增多。

Objectives To compare and analyze clinical efficacy of the stagger C-tissue selecting therapy(SC-TST)and the pro⁃cedure for prolapse and hemorrhoids(PPH)in the treatment of circumferential mixed hemorrhoids.Methods The clinical data of 148 patients with circumferential mixed hemorrhoids admitted to the Department of General Surgery,Qingdao Fuwai Cardiovas⁃cular Hospital and Department of Anorectal Surgery,The Third People’s Hospital of Qingdao from December 2017 to January 2021 were retrospectively analyzed.They were randomized to the observation group(SC-TST)and the control group(PPH),with 74 cases in each group.Clinical efficacy,surgical parameters(operation time,intraoperative bleeding,hospitalization time and hos⁃pitalization cost),and postoperative complications(anal swelling and re-bleeding at 2 weeks after surgery,recto-anal stricture and residual anastomotic staples at 3 months after surgery)and recurrence were compared between the two groups.Results The total effective rate was 100%in both groups.There was no statistically significant difference between the clinical efficacy of the two groups(P>0.05).In the observation group,the operation time was longer than that of the control group and the hospitaliza⁃tion cost was higher than that of the control group(P<0.05);there was no statistically significant difference between the two groups in terms of intraoperative bleeding and hospitalization time(P>0.05).There were no recurrence cases in both groups at 5 months after surgery.There was no statistically significant difference in the incidence of anal swelling and re-bleeding at 2 weeks after surgery between the two groups(P>0.05);the incidence of recto-anal stricture and residual anastomotic staples at 3 months after surgery was lower in the observation group than in the control group(P<0.05).Conclusion Compared with PPH,SC-TST has comparable clinical efficacy in the treatment of circumferential mixed hemorrhoids,reducing the incidence of postop⁃erative recto-anal stricture,residual anastomotic staples and reducing recurrence without increasing the incidence of postoperative anal swelling and re-bleeding,but with longer operation time and higher hospitalization cost.