选择性痔上黏膜切除吻合术治疗Ⅲ度混合痔的5-HT、PGE2及IL-6水平变化及疗效

Changes of 5⁃HT,PGE2 and IL⁃6 levels in patients with gradeⅢmixed hemorrhoids treated with selective hemorrhoidal superior mucosa resection and anastomosis

目的 分析选择性痔上黏膜切除吻合术(TST)治疗Ⅲ度混合痔的神经递质及5-羟色胺(5-HT)、前列腺素E2(PGE2)及白介素-6(IL-6)水平变化及临床疗效。方法 本研究采用单中心回顾性研究方法,收集2020年5月至2023年1月大连市中心医院收治的108例Ⅲ度混合痔患者,依据治疗方式分为对照组[n=53,予吻合器痔上黏膜环切术(PPH)治疗]和观察组(n=55,予TST治疗)。对比两组临床疗效、围手术期指标(手术时长、术中出血量、住院时间、术后首次排便时间、术后卧床时间)、5-HT、PGE2、炎性因子[IL-6、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平]、肛肠动力学指标[直肠感知阈值(RSTV)、肛管静息压(RASP)、直肠最大容量阈值(RMTV)]及并发症发生率。结果 观察组临床总有效率(94.55%)比对照组(81.13%)高,差异有统计学意义(P<0.05);观察组术后首次排便时间、手术时长、术后卧床时间及住院时间比对照组短,术中出血量比对照组少,差异有统计学意义(P<0.05);治疗后,两组5-HT、PGE2水平均下降,且观察组比对照组低,差异有统计学意义(P<0.05);治疗后,两组IL-6、CRP、TNF-α水平均下降,且观察组比对照组低,差异有统计学意义(P<0.05);治疗后,观察组RSTV、RMTV比对照组高,RASP比对照组低,差异有统计学意义(P<0.05);观察组并发症总发生率(7.28%)比对照组(20.75%)低,差异有统计学意义(P<0.05)。结论 采用TST治疗Ⅲ度混合痔患者疗效更显著,明显改善了患者围术期指标,降低了患者5-HT、PGE2及IL-6、TNF-α、CRP炎性因子水平,降低术后并发症发生率,利于术后恢复。

Objective To analyze the changes in neurotransmitter levels,specifically 5-hydroxy-tryptamine(5-HT),prostaglandin E2(PGE2)and interleukin-6(IL-6),in gradeⅢmixed hemorrhoids treat-ed with selective superior hemorrhoidal mucosal resection and anastomosis(TST).Methods In this study,108 patients with grade III mixed hemorrhoids were retrospectively collected from Dalian Central Hospital be-tween May 2020 and January 2023.They were divided into a control group(n=53,treated with procedure for prolapse and hemorrhoids)and an observation group(n=55,treated with tissue-selecting therapy staple).Clin-ical efficacy,perioperative indicators(operation time,intraoperative blood loss,hospitalization time,postop-erative first defecation time,postoperative bed time),5-HT,PGE2,inflammatory factors(interleukin-6,C-reactive protein,tumor necrosis factor-αlevels),anorectal dynamic indicators(rectal sensing threshold,anal resting pressure,rectal maximum volume threshold)and complications were compared between the two groups to assess the incidence of symptoms.Results The total effective rate of the observation group(94.55%)was higher than that of the control group(81.13%),and the difference was statistically significant(P<0.05).The first postoperative defecation time,operation time,postoperative bedtime,and hospitalization time in the observation group were shorter than those in the control group,and the intraoperative blood loss was less than that in the control group,the difference was statistically significant(P<0.05).After treatment,the levels of 5-HT and PGE2 in both groups decreased,with levels in the observation group lower than those in the control group,the difference was statistically significant(P<0.05).Similarly,the levels of IL-6,CRP,and TNF-αin both groups decreased,after treatment,with levels in the observation group lower than those in the control group,the difference was statistically significant(P<0.05).Additionally,RSTV and RMTV in the observation group were higher than those in the control group,while RASP was lower,the difference was sta-tistically significant(P<0.05).The total incidence of complications in the observation group(7.28%)was low-er than that in the control group(20.75%),the difference was statistically significant(P<0.05).Conclusion TST is more effective in treating gradeⅢmixed hemorrhoids.It can significantly improve perioperative index-es in patients with this condition.Levels of inflammatory factors such as 5-HT,PGE2,IL-6,CRP,and TNF-αare reduced,and postoperative complications are decreased.This is beneficial for postoperative recovery.