改良吻合器痔上黏膜环切术联合部分肛门内括约肌切断术治疗环状混合痔的临床疗效及安全性研究

Clinical efficacy and safety of modified proceedure for prolapse and hemorrhoids combined with partial internal anal sphincterotomy in the treatment of annular mixed hemorrhoids

目的 探讨改良吻合器痔上黏膜环切术(PPH)联合部分肛门内括约肌切断术治疗环状混合痔的临床疗效及安全性。方法 2018年~2021年我院收治环状混合痔病人105例,采用完全随机对照方法分为两组,观察组54例,采用改良PPH术联合部分肛门内括约肌切断术,对照组51例,采用常规PPH术。对比两组病人术后各项指标、围手术期及中远期并发症发生率,观察临床疗效及安全性。结果 观察组手术时间(48.35±4.37)分钟,大于对照组的(36.42±6.21)分钟(P<0.05);观察组术后吻合口狭窄发生率为1.9%,少于对照组的15.6%(P<0.05);观察组肛门疼痛、尿潴留、首次排便时间、远期肛门坠胀优于对照组,差异有统计学意义(P<0.05);观察组住院时间为(4.8±0.62)天,对照组为(5.1±0.54)天,两组比较差异无统计学意义(P>0.05),观察组术中出血量和吻合口出血率分别为(17.28±2.22)ml和3.7%,对照组分别为(16.75±2.13)ml和3.9%,两组比较差异无统计学意义(P>0.05)。两组创面愈合时间比较差异无统计学意义(P>0.05)。结论 改良PPH术联合部分肛门内括约肌切断术对比常规PPH术,手术时间略有增加,但不增加吻合口出血风险,不增加直肠漏发生率,且不会增加手术出血量及住院时间,可明显改善术后肛门疼痛、尿潴留、远期坠胀症状,缩短首次排便时间,缓解排便困难,并显著降低PPH术后吻合口狭窄,远期疗效及安全性较好。

Objective To explore the clinical efficacy and safety of modified PPH combined with partial internal anal sphincterotomy in the treatment of circular mixed hemorrhoids.Methods Patients with annular mixed hemorrhoids were divided into two groups by a completely randomized controlled method.54 patients in the experimental group were treated with modified PPH combined with partial internal anal sphincterotomy,while 51 patients in the control group were treated with conventional PPH.The postoperative indicators,perioperative and long⁃term complication rates of the two groups were compared,and the clinical efficacy and safety were observed.Results The operation time in the experimental group was(48.35±4.37)minutes,which was higher than that in the control group(36.42±6.21)minutes(P<0.05).The incidence of postoperative anastomotic stenosis in the experimental group was 1.9%,lower than 15.6%in the control group(P<0.05).Anal pain,urinary retention,first defecation time,long⁃term anal distention,the experimental group was significantly better than the control group,the difference was statistically significant(P<0.05);The hospitalization time in the experimental group(4.8±0.62)days was not significantly different from that in the control group(5.1±0.54)days(P>0.05).The amount of intraoperative bleeding and anastomotic bleeding in the experimental group[(17.28±2.22)ml,3.7%]were not significantly different from those in the control group[(16.75±2.13)ml,3.9%](P>0.05).Conclusion Compared with conventional PPH,the modified PPH combined with partial internal anal sphincterotomy slightly increases the operation time,but does not increase the risk of anastomotic bleeding,the incidence of rectal fistula,the amount of surgical bleeding,and the length of hospital stay.It can significantly improve postoperative anal pain,urinary retention,long⁃term distention symptoms,shorten the time of first defecation,ease the difficulty of defecation,and significantly reduce postoperative anastomotic stenosis,The long⁃term efficacy and safety are good.