RPH联合简化外切内扎术治疗轻中度混合痔98例

Clinical effect of automatic ligation of hemorrhoids combined with simplified Milligan-Morgan hemorrhoidectomy in treatment of mild-to-moderate mixed hemorrhoids:An analysis of 98 cases

目的:观察自动弹力线痔套扎术(RPH)联合简化外切内扎术治疗轻中度混合痔的临床疗效及卫生经济学指标。方法:将196例轻中度混合痔患者完全随机分为治疗组与对照组,每组各98例。治疗组予RPH联合简化外切内扎术治疗,对照组予痔上黏膜环切钉合术(PPH)联合简化外切内扎术治疗。比较2组术中出血量、手术时间、创面愈合时间,术后第1、3、5、7天疼痛情况及术后1个月并发症发生情况,卫生经济学指标(包括住院天数、住院药品费用、住院总费用、住院期间药物费用占比),评价2组术后1、3个月的综合疗效。结果:术后1、3个月总有效率治疗组分别为96.94%(95/98)、98.98%(97/98),对照组分别为87.76%(86/98)、92.86%(91/98),2组比较,差异均有统计学意义(P<0.05)。治疗组术中出血量少于对照组,手术时间、创面愈合时间均短于对照组(均P<0.01);术后第1、3天2组疼痛视觉模拟法(VAS)评分差异无统计学意义(P>0.05),术后第5、7天治疗组疼痛VAS评分低于对照组(P<0.05);术后1个月并发症发生率治疗组为11.22%(11/98),低于对照组的24.49%(24/98),差异有统计学意义(P<0.05);治疗组住院天数、住院药品费用、住院总费用均少于对照组(P<0.01),但2组住院期间药物费用占比差异无统计学意义(P>0.05)。结论:相比于PPH联合简化外切内扎术,RPH联合简化外切内扎术治疗轻中度混合痔有更好的临床疗效,能减轻患者经济负担,更加适合临床推广及应用。

Objective:To investigate the clinical effect of automatic ligation of hemorrhoids(RPH)combined with simplified Milligan-Morgan hemorrhoidectomy in the treatment of mild-to-moderate mixed hemorrhoids and its health economics indicators.Methods:A total of 196 patients with mild-to-moderate mixed hemorrhoids were randomly divided into treatment group and control group,with 98 patients in each group.The patients in the treatment group were given RPH combined with simplified Milligan-Morgan hemorrhoidectomy,and those in the control group were given procedure for prolapse and hemorrhoids(PPH)combined with simplified Milligan-Morgan hemorrhoidectomy.The two groups were compared in terms of intraoperative blood loss,time of operation,wound healing time,pain on days 1,3,5,and 7 after surgery,complications at 1 month after surgery,and health economics indicators(including length of hospital stay,drug costs during hospitalization,total hospital costs,and proportion of drug costs during hospitalization),and overall response was evaluated at 1 and 3 months after surgery.Results:There was a significant difference in overall response rate between the treatment group and the control group at 1 and 3 months after surgery[1 month:96.94%(95/98)vs 87.76%(86/98),P<0.05;3 months:98.98%(97/98)vs 92.86%(91/98),P<0.05].Compared with the control group,the treatment group had a significantly lower intraoperative blood loss and significantly shorter time of operation and wound healing time(all P<0.01).There was no significant difference in Visual Analogue Scale(VAS)score of pain between the two groups on days 1 and 3 after surgery(P>0.05),and the treatment group had a significantly lower VAS score of pain than the control group at 5 and 7 days after surgery(P<0.05).Compared with the control group,the treatment group had a significantly lower incidence rate of complications at 1 month after surgery[11.22%(11/98)vs 24.49%(24/98),P<0.05].Compared with the control group,the treatment group had a significantly shorter length of hospital stay and significantly lower drug costs during hospitalization and total hospital costs(P<0.01),but there was no significant difference in the proportion of drug costs during hospitalization between the two groups(P>0.05).Conclusion:Compared with PPH combined with simplified Milligan-Morgan hemorrhoidectomy,RPH combined with simplified Milligan-Morgan hemorrhoidectomy has a better clinical effect in the treatment of mild-to-moderate mixed hemorrhoids and can reduce the economic burden of patients,and therefore,it holds promise for clinical application.