直肠上动脉栓塞术治疗Ⅱ~Ⅲ期内痔的疗效分析

Evaluation of intraoperative blood loss,pain and clinical efficacy of upper rectal artery embolization in patients withⅡtoⅢstage hemorrhoids

目的 探讨直肠上动脉(SRA)栓塞术治疗Ⅱ~Ⅲ期内痔的效果及对术中出血量及疼痛度的影响。方法 选取2021年1月~2022年1月期间在本院就医并确诊为Ⅱ~Ⅲ期内痔病人共84例,按照手术干预方式的不同分为PPH组及SRA栓塞组,每组均42例。PPH组应用痔上黏膜环形切除钉合术式干预治疗,SRA栓塞组应用SRA栓塞术进行治疗。对比两组病人临床疗效、围术期各项指标、肛门症状情况、术后疼痛程度、肛肠动力学指标、术后并发症发生率等,术后随访12个月,观察内痔复发情况。结果 SRA栓塞组和PPH组术后12个月临床治疗总有效率分别为92.86%和76.19%,手术时间分别为(17.23±4.26)分钟和(43.16±9.37)分钟、住院时间分别为(5.52±1.89)天和(8.25±2.67)天,创面愈合时间分别为(7.36±2.23)天和(17.83±4.04)天,术中出血量分别为(10.03±2.38)ml和(16.22±3.11)ml,手术费用分别为(14327.36±892.23)元和(2762.83±524.04)元,术后12个月术后肛门失禁分别为(0.45±0.02)分和(0.60±0.09)分、肛门疼痛分别为(3.04±0.14)分和(5.15±1.68)分、肛门出血分别为(0.43±0.08)分和(0.61±0.19)分、肛缘水肿分别为(0.29±0.09)分和(0.52±0.16),两组比较差异有统计学意义(P<0.05);术后12个月SRA栓塞术组和PPH组直肠静息压(RRP)分别为(2.41±0.35)kPa和(2.95±0.29)kPa,肛管静息压(ARP)分别为(13.14±1.51)kPa和(14.67±1.59)kPa,肛管最大收缩压(AMCP)分别为(14.22±0.28)kPa和(13.35±0.23)kPa,术后12个月并发症总发生率分别为4.76%和21.43%,两组比较差异有统计学意义(P<0.05)。均接受12个月随访,SRA栓塞术组有13例内痔复发;PPH组有10例内痔复发,两组比较,差异无统计学意义(P>0.05)。结论 SRA栓塞治疗Ⅱ~Ⅲ期内痔病人可有效提高临床疗效,对促进病人快速恢复、改善疼痛度等症状有积极意义。

Objective To investigate the effect of upper rectal artery(SRA)embolization on clinical treatment,intraoperative blood loss and pain in patients with stageⅡtoⅢhemorrhoids.Methods A total of 84 patients diagnosed with stageⅡtoⅢhemorrhoids in our hospital from January 2021 to January 2022 were selected.According to different surgical interventions,PPH group and SRA group were established,with 42 cases in each group.The PPH group was treated with hemorrhoid mucosa ring resection and nailing operation,and the SRA group was treated with upper rectal artery embolization.The clinical efficacy,perioperative indicators,anal symptoms,postoperative pain,anorectal dynamics indicators,and incidence of postoperative complications were compared between the two groups.All patients received a 6-month follow-up survey after the operation,and the recurrence of hemorrhoids during the follow-up period was collected,and Kaplan-Meier curve was used for comparative analysis.Results The total effective rates of SRA group and PPH group at 12 months after operation were 92.86%and 76.19%,operation time was(17.23±4.26)min and(43.16±9.37)min,hospital stay was(5.52±1.89)d and(8.25±2.67)d,wound healing time was(7.36±2.23)d and(17.83±4.04)d,the intraoperative blood loss was(10.03±2.38)ml and(16.22±3.11)ml,and the operative cost were(14327.36±892.23)yuan and(2762.83±524.04)yuan,postoperative anal incontinence was(0.45±0.02)points and(0.60±0.09)points,anal pain score was(3.04±0.14)points and(5.15±1.68)points,anal bleeding scores was(0.43±0.08)points and(0.61±0.19)points,symptom scores of anal border edema was(0.29±0.09)points and(0.52±0.16)points,respectively.The difference between the two groups was statistically significant(all P<0.05).Postoperative rectal resting pressure(RRP)[(2.41±0.35)kPa vs.(2.95±0.29)kPa]and anal canal resting pressure(ARP)[(13.14±1.51)kPa vs.(14.67±1.59)kPa]levels between the SRA group and PPH group were statistically significant at 12 months after surgery(P<0.05).Postoperative maximum systolic blood pressure(AMCP)of anal canal in SRA group[(14.22±0.28)kPa]was significantly higher than that in PPH group[(13.35±0.23)kPa](P<0.05).The total incidence of complications 12 months after operation in SRA group was significantly lower than that in PPH group(4.76%vs.21.43%)(P<0.05).After surgery,both groups were followed up for 12 months.In SRA group,13 cases(30.95%)recurred internal hemorrhoids.In the PPH group,10 patients(23.81%)had internal hemorrhoid recurrence,and there was no significant difference between the two groups(P>0.05).Conclusion SRA can effectively improve clinical efficacy in the treatment of stageⅡtoⅢhemorrhoids patients,and has positive significance in promoting rapid recovery of patients and improving adverse symptoms such as pain degree.