外痔超声刀切剥后锁边缝合治疗静脉曲张性环状混合痔的临床观察

Efficacy of external hemorrhoid ultrasonic knife incision and stripping followed by locking edge suture on varicose circumferential mixed hemorrhoids

目的观察外痔超声刀切剥后锁边缝合联合内痔套扎术治疗静脉曲张性环状混合痔的临床疗效。方法选择2020年8月—2021年6月在上海市金山区中西医结合医院肛肠科手术治疗的静脉曲张性环状混合痔患者60例为研究对象,基于治疗方式不同分为2组,治疗组30例采用外痔超声刀切剥后锁边缝合联合内痔套扎治疗,对照组30例采用外痔超声刀切剥联合内痔套扎治疗,观察2组患者的手术时长、术中出血量、创面愈合时间及术后便血、肛缘水肿、肛门疼痛、肛门皮赘、肛门狭窄等情况,随访6个月观察复发情况。结果2组手术时长比较差异均无统计学意义(P均>0.05)。与对照组比较,治疗组术中出血量更少,术后创面愈合时间更短,差异均有统计学意义(P均<0.05)。和同期对照组相比,治疗组术后便血(术后第1,3,7天)、肛缘水肿(术后第3天)、肛门疼痛(术后第7天)和肛门皮赘(术后第14天)评分均更低(P均<0.05);2组术后疗效比较差异无统计学意义(P>0.05),2组均无肛门狭窄、肛门失禁发生,随访无复发。结论超声刀切剥后锁边缝合技术治疗静脉曲张性环状混合痔效果显著,术中出血量相对较少,可促进肛门创面更快愈合,有较高的安全性。

Objective It is to observe the clinical efficacy of external hemorrhoid ultrasonic knife incision and stripping followed by locking edge suture combined with internal hemorrhoid ligation in the treatment of varicose circumferential mixed hemorrhoids.Methods Sixty patients with varicose circumferential mixed hemorrhoids who were surgically treated in the Department of Anus and Intestines of Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine from August 2020 to June 2021 were selected as the study objects,and were divided into 2 groups according to their treatment,30 cases in the treatment group were treated with external hemorrhoid ultrasonic knife incision and stripping followed by locking edge suture combined with internal hemorrhoid ligation,and 30 cases in the control group were treated with external hemorrhoid ultrasonic knife incision and stripping combined with internal hemorrhoid ligation.The operation time,intraoperative bleeding,wound healing time,and postoperative blood in stool,circumanal edema,anal pain,anal skin tag,anal stenosis of the patients in both groups were observed,and the recurrence was observed after 6 months of follow-up.Results The difference in the operation time was not statistically significant between the two groups(P>0.05).Compared with the control group,the intraoperative bleeding was less and postoperative wound healing time was shorter in the treatment group,and the differences were all statistically significant(all P<0.05).Compared with the control group in the same period,the scores of postoperative blood in stool(on the 1 st,3 rd,7 th days),circumanal edema(on the 3 rd day),day 3),anal pain(on the 7 th day),and anal skin tag(on the 14 th day)were more lower in the treatment group(all P<0.05);there was no significant difference in postoperative efficacy between the two groups(P>0.05),and no anal stenosis or anal incontinence occurred in either of the two groups,and there were no recurrences at the follow-up visit.Conclusion The efficacy of ultrasonic knife incision and stripping followed by locking edge suture is remarkable in the treatment of varicose circumferential mixed hemorrhoids,its intraoperative bleeding is relatively less,and can promote faster healing of the anal wound with high safety.