微创切口保留肛垫皮瓣粘膜结扎切除术治疗环状混合痔

Anal cushions-preserving ligation resection for the treatment of circumferential mixed hemorrhoids

目的 探讨治疗环状混合痔新手术方式。 方法 微创切口保留肛垫皮瓣粘膜结扎切除术治疗环状混合痔187例 ,外剥内扎术治疗 77例为对照组 ,对比观察创面愈合时间、肛门功能测定、术后并发症等指标。 结果 创面愈合时间 :治疗组 (17± 4)d ,对照组 (2 4± 4)d(t=9.2 4,P <0 .0 1)。肛管静息压测定 :治疗组术后 (5 1± 17)mmHg ,术前 (6 4± 17)mmHg(t =5 .85 ,P <0 .0 1) ;对照组术后 (74± 2 3)mmHg ,术前 (6 2± 18)mmHg(t=7.2 9,P <0 .0 1)。治疗组术后未出现肛门狭窄情况 ;对照组有 9例 (11.7% )出现不同程度的肛门狭窄。水肿发生率 :治疗组 14.4% ,对照组 14.3% (χ2 =0 .15 ,P >0 .0 5 )。术后 2 4小时排尿困难 :治疗组 14.4% ,对照组 2 7.3% (χ2 =8.42 ,P <0 .0 1)。术后肛门下坠 :治疗组 5 .9% ,对照组 2 2 % (χ2 =11.5 ,P <0 .0 1)。 结论 保留肛垫皮瓣粘膜结扎切除术治疗环状混合痔较外剥内扎术可缩短创面愈合时间 ,保持肛门正常的生理结构及功能 。

Ojective To evaluate a new operation procedure for the treatment of circumferential mixed hemorrhoids. Methods 187 cases were treated by anal pad-preserving ligation resection, while 77 cases by routine procedures of stripping off the varicose masses of the external hemorrhoids and ligation the internal one as the control. Results Healing time of the operative wound were (17±4)d in the the study group and (24±4)d in the controls respectively( t =9.24, P <0.01). Resting post-and pre-operative pressure of anal canal:(51±17)mmHg and (64±17)mmHg in the study group( t =5.85, P <0.01);(74±23)mmHg and (62±18)mmHg in the controls( t =7.29, P <0.01). No Postoperative stricture of anus developed in the study group but 9 cases (11.7%) in the controls. Edema: 14.4% of patients occurred in the study group, 14.3% of patients in the controls(χ 2=0.15, P >0.05). Postoperative urinary dysfunction: 14.4% of cases developed in the study group and 27.3% in the controls(χ 2=8.42, P <0.01). Tenesmus:5.9% in the study group and 22% in the controls(χ 2=11.5, P <0.01). Conclusions As compared with the routine procedure in the treatment of circumferential mixed hemorrhoids, the new technique increased the cure rate, shortened the healing time of the operative wound, retain better physiological functions of anus, and decreased postoperative complications.