PPH术与STARR术对Ⅳ度混合痔患者康复效果的影响

Comparison of the rehabilitation effect of PPH and STARR in patients with grade IV mixed hemorrhoids

目的:比较吻合器痔上黏膜环切钉合(Procedure for prolapse and hemorrhoids,PPH)术与经肛吻合器直肠切除(Stapled trans-anal rectal resection,STARR)术对Ⅳ度混合痔患者康复效果的影响。方法:选取2021年1月至2023年12月南阳市第二人民医院收治的Ⅳ度混合痔患者86例,随机分为STARR术组和PPH术组(n=43),分别采用STARR术和PPH术治疗。住院期间比较两组手术及术后恢复指标;术前、术后12 h、24 h、36 h,采用视觉疼痛模拟量表(Visual analogue scale,VAS)评估疼痛程度;术前、术后3 d,采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-17(Interleukin-17,IL-17)、高敏C反应蛋白(Highly sensitive C-reactive protein,hs-CRP);术后3 d,比较两组排便功能恢复及并发症情况。结果:PPH术组术中总失血量低于STARR术组,手术用时、住院天数、创面愈合时间短于STARR术组(P<0.05);术后12 h、24 h、36 h,PPH术组VAS评分均低于STARR术组(P<0.05);术后3 d,PPH术组血清TNF-α、IL-17、hs-CRP水平低于STARR术组(P<0.05);术后3 d,PPH术组术后排便功能恢复优于STARR术组(P<0.05);PPH术组术后并发症总发生率低于STARR术组(P<0.05)。结论:PPH术治疗Ⅳ度混合痔能缩短手术用时,减少术中出血,减轻炎症反应,降低术后疼痛,改善术后排便功能,加快康复进程。

Objective:To compare the rehabilitation effect of the procedure for prolapse and hemorrhoids(PPH)and stapled trans-anal rectal resection(STARR)in patients with grade IV mixed hemorrhoids.Methods:A total of 86 patients with grade IV mixed hemorrhoids admitted to The Second People's Hospital of Nanyang City from January 2021 to December 2023 were collected and randomly divided into the STARR group and PPH group(n=43),they were treated with STARR and PPH,respectively.After surgery,the surgical and postoperative recovery indexes were compared between the two groups.Before and after 12 hours,24 hours,and 36 hours of surgery,the visual analogue scale(VAS)was used to assess the pain level.Before and after 3 days of surgery,the enzyme-linked immunosorbent assay was used to detect the tumor necrosis factor-α(TNF-α),interleukin-17(IL-17),and highly sensitive C-reactive protein(hs-CRP)levels.After 3 days of surgery,defecation function and complications were compared between the two groups.Results:The total blood loss in the PPH group was lower than that in the STARR group,and the operation time,hospital stay,and wound healing time were shorter than those in the STARR group(P<0.05).After 12 hours,24 hours,and 36 hours of operation,the VAS scores in the PPH group were lower than those in the STARR group(P<0.05).After 3 days of operation,the serum levels of TNF-α,IL-17,and hs-CRP in the PPH group were lower than those in the STARR group(P<0.05).After 3 days of operation,the recovery of defecation function in the PPH group was better than the STARR group(P<0.05).The total incidence of postoperative complications in the PPH group was lower than that in the STARR group(P<0.05).Conclusion:PPH for grade IV mixed hemorrhoids can shorten the operation time,reduce intraoperative bleeding,reduce inflammation,reduce postoperative pain,improve postoperative defecation function,and accelerate the rehabilitation process.