PPH加硬注术在重度混合痔中的应用价值

Application Value of PPH Plus Hard Injection Operation in Severe Mixed Hemorrhoids

目的:探讨吻合器痔上黏膜环形切除术(PPH)加硬注术治疗重度混合痔的效果。方法:选取泉州市泉港区医院2019年6月-2021年6月150例重度混合痔患者。随机将其分为对照组和研究组,各75例。对照组给予外剥内扎术治疗,研究组给予PHH加硬注术治疗。比较两组围手术期指标、并发症、术前及术后1 d炎症因子及应激指标、手术效果。结果:研究组手术时间及术后住院时间均短于对照组,术中出血量少于对照组,术后首次排便疼痛评分、术后痔核大小均低于对照组(P<0.05);两组尿潴留、肛门出血发生率比较差异均无统计学意义(P>0.05),但研究组发生率稍低;研究组肛缘水肿发生率低于对照组(P<0.05);与术前相比,两组术后1 d皮质醇(Cor)、C反应蛋白(CRP)水平均有所升高(P<0.05),研究组术后1 d Cor、CRP水平均低于对照组(P<0.05)。两组总有效率比较差异无统计学意义(P>0.05)。结论:重度混合痔患者采用PPH加硬注术治疗,能缩短手术时间,缩小痔核,降低肛缘水肿发生率,减轻术后疼痛感,缩短住院时间,减轻机体应激反应,安全有效,值得临床推荐。

Objective:To investigate the effect of procedure for prolapse and hemorrhoids(PPH)plus hard injection operation in the treatment of severe mixed hemorrhoids.Method:A total of 150 patients with severe mixed hemorrhoids in Quangang District Hospital of Quanzhou from June 2019 to June 2021 were selected.They were randomly divided into control group and study group,75 cases in each group.The control group was treated with external stripping and internal ligation operation,while the study group was treated with PPH plus hard injection operation.The perioperative indexes,complications,inflammatory factors,stress indexes before and 1 d after operation and surgical effects were compared between the two groups.Result:The operation time and postoperative hospital stay in the study group were shorter than those in the control group,the amount of intraoperative bleeding was less than that in the control group,and the score of postoperative first defecation pain and the size of postoperative hemorrhoids were lower than those in the control group(P<0.05).There were no significant differences in the incidences of urinary retention and bleeding between the two groups(P>0.05),but the incidence of the study group was slightly lower;the incidence of perianal edema in the study group was lower than that in the control group(P<0.05).Compared with before operation,the levels of cortisol(Cor)and C-reactive protein(CRP)in the two groups increased 1 d after operation(P<0.05),and the levels of Cor and CRP in the study group were lower than those in the control group on the first day after operation(P<0.05).There was no significant difference in the total effective rate between the two groups(P>0.05).Conclusion:The use of PPH plus hard injection operation treatment in patients with severe mixed hemorrhoids can shorten the operation time,shrink hemorrhoids,reduce the incidence of perianal edema,reduce postoperative pain,shorten hospital stay,and reduce the stress response of the body.It is safe and effective,and is worthy of clinical recommendation.