肛管复位隧道式外剥内悬吊术治疗肛管下垂型环状混合痔

Anal canal reduction by external decollement through tunnel and internal suspension in the treatment of circumferential mixed hemorrhoids with anal canal prolapse

目的探讨肛管复位隧道式外剥内悬吊术治疗肛管下垂型环状混合痔的临床疗效。方法选取肛管下垂型环状混合痔患者120例,随机分为肛管复位隧道式外剥内悬吊术组(治疗组)、传统手术组、痔上黏膜环形切除钉合术组(PPH组),每组40例,比较3个组手术时间、住院时间、术后3 d内疼痛评分、术后并发症(肛门水肿、出血、尿潴留、肛门下坠等)发生率,术后3个月随访各组感染、肛门狭窄、大便失禁的发生情况。结果治疗组在术后3 d的疼痛方面均优于传统手术组(P<0.05),治疗组手术时间及住院时间介于另外两个组之间,且差异有统计学意义(P<0.001)。治疗组在肛门下坠方面优于另外两组(P<0.05)。在术后迟发性出血、水肿、尿潴留、感染、脓肿、肛门狭窄及大小便失禁的发生率上,3个组差异无统计学意义。结论肛管复位隧道式外剥内悬吊术在治疗肛管下垂型环状混合痔具有明显优势。

Objective To explore the clinical efficacy of anal canal reduction by external decollement through tunnel and internal suspension in the treatment of circumferential mixed hemorrhoids w ith anal canal prolapse.Methods A total of 120 cases of circumferential mixed hemorrhoids w ith anal canal prolapse w ere randomly divided into 3 groups:patients in the treatment group w ere treated w ith anal canal reduction by external decollement through tunnel and internal suspension(n=40);patients in the conventional group received traditional operation(n=40);patients in the procedure for prolapsed hemorrhoids(PPH)group w ere managed w ith procedure for prolapsed hemorrhoids(n=40).The operation time,hospital stay,pain score w ithin 3 days after operation,and incidence of postoperative complications(anal edema,hemorrhage,urine retention,rectal tenesmus)w ere compared.Three months after surgery,the incidence of infection,anal stenosis and fecal incontinence w ere follow ed up.Results The treatment group suffered less pain w ithin 3days after operation than the conventional group(P<0.05);the operation time and hospital stay of the treatment group ranked second among the three groups,and the differences w ere statistically significant(P<0.001).The treatment group had low er incidence of rectal tenesmus than the other tw o groups(P<0.05).There w ere no statistically significant differences in the incidences of delayed bleeding,anal edema,urine retention,infection,absess,anal stenosis and fecal incontinence among the three groups.Conclusion Anal canal reduction by external decollement through tunnel and internal suspension has remarkably better efficacy than the conventional operation and PPH in treating circumferential mixed hemorrhoids w ith anal canal prolapse.