日间手术模式下吻合器痔上黏膜环切术与外剥内扎术治疗混合痔的临床疗效对比

A comparative study of the clinical efficacy of procedure for prolapse and hemmorhoids and milligan-morgan hemorrhoidectomy in the treatment of mixed hemorrhoids under the day surgery mode

目的比较日间手术模式下吻合器痔上黏膜环切术(PPH)与外剥内扎术(MMH)治疗混合痔的临床疗效。方法回顾性收集2019年10月至2021年5月在新疆医科大学第一附属医院日间手术治疗病房接受手术治疗的161例混合痔病人的临床资料。按手术方式的不同分为两组:P组病人接受PPH,共96例,M组接受MMH,共65例。比较两组病人住院时间、住院总费用、手术切口视觉模拟法(VAS)疼痛评分、术后延迟出院率、非计划再入院率、术后复发率以及临床疗效等资料。术后随访6个月。结果P组与M组在治愈率(94.79%比96.92%)、延迟出院率(10.42%比12.31%)、住院时间以及术后复发率等方面比较均差异无统计学意义(P>0.05)。M组非计划再入院率(0.00%比7.29%)、住院总费用低于P组,均差异有统计学意义(P<0.05)。P组术后1、3、5、7d的VAS疼痛评分均小于M组,均差异有统计学意义(P<0.05)。结论日间手术模式下MMH与PPH有同样的临床疗效,同时MMH住院总费用更低且更为安全。PPH虽然有着较小的术后疼痛,但是术后非计划再入院率较高,故目前在日间模式下需谨慎使用。

Objective To compare the clinical efficacy of procedure for prolapse and hemmorhoids(PPH)and milligan-morgan hemorrhoidectomy(MMH)in the treatment of mixed hemorrhoids under the day surgery mode.Methods The clinical data of 161 patients with mixed hemorrhoids who underwent surgical treatment in the day surgery treatment ward of the First Affiliated Hospital of Xinjiang Medical University from October 2019 to May 2021 were retrospectively collected.The patients were assigned into two groups according to the different surgical methods:patients in group P underwent PPH for a total of 96 cases and group M underwent MMH for a total of 65 cases.Information on hospitalization time,total hospitalization cost,visual analogue scale(VAS)pain score,postoperative delayed discharge rate,unplanned readmission rate,postoperative recurrence rate,and clinical efficacy were compared between the two groups.Postoperative follow-up was 6 months.Results The differences between the two groups in terms of cure rate(group P:94.79%,group M:96.92%),delayed discharge rate(group P:10.42%,group M:12.31%),length of stay,and postoperative recurrence rate were not statistically significant(all P>0.05).The unplanned readmission rate(group P:7.29%,group M:0.00%)and total hospitalization cost of patients in group M were lower than those in group P,and the differences were statistically significant(P<0.05).The VAS pain scores of patients in group P were lower than those in group M at 1 d,3 d,5 d,7 d after surgery,and the differences were statistically significant(P<0.05).Conclusions MMH in day surgery mode has the same clinical efficacy as PPH,and MMH has a lower total cost of hospitalization and is safer.PPH has less postoperative pain,but has a higher rate of unplanned readmissions,so it should be used with caution in day surgery mode.