齿状线上黏膜瓣切除和开放切除处理痔上黏膜环切术后残余外痔的对比研究  

Rectal Mucosal Flap Excision and Open Excision for Treatment of Residual Extenal Hemorrhoids after the Procedure for Prolapsed Hemorrhoids： A Randomised Controlled Trial

作　　者：陶琦[1] 刘永安[1] 张东平[1] 柳发林[1] 刘娟[1] 

机构地区：[1]长江大学附属第一医院肛肠外科,湖北荆州434000

出　　处：《医学新知》2010年第2期78-80,共3页New Medicine

摘　　要：目的比较齿状线上直肠黏膜瓣切除法和开放式切除法处理痔上黏膜环形切除钉合术（procedure for prolapsed hemorrhoids，PPH）后残余外痔及皮赘的临床效果。方法180例Ⅲ～Ⅳ度混合痔行PPH术后残存外痔及皮赘者158例。对其中82例行齿状线上直肠黏膜瓣切除（A组），76例行开放式切除（B组），对比观察2组术后疼痛指数、术后并发症发生率、手术时间、住院时间、创口愈合时间、患者满意度。结果术后疼痛指数A组（2．1±0．8）明显低于B组（7．5±1．2）（P〈0．01）；术后并发症比较，A组肛缘水肿（1．2％）少于B组（13．2％）（P〈0．05），余无明显差异；手术时间、创口愈合时间、住院时间A组和B组分别为（25±6．5）与（15．2±2．8）（P〈0．01），（8±3．5）与（21±8．5）（P〈0．01）和（4．0±1．0）与（6．0±1．5）（P〈0．01）；术后患者满意度评分2组均较高但无明显差异（117．5±15．5，112．5±22）（P〉0．05）。结论齿状线上直肠黏膜瓣切除法处理PPH术后残余外痔及皮赘的近期疗效优于开放式切除法。Objective To compare the efficacies of procedures for rectal mucosal flap excision and open excision in the treatment of residual skin tag following the procedure for prolapse and hemorrhoids （PPH）. Methods One hundred and eighty patients with grade II/ - 1V hemorrhoids were randomly divid- ed into two groups and all were treatment with PPH, in which 82 patients underwent rectal mucosal flap excisions and 76 patients underwent open excisions for residual skin tag following PPH. Pain scores, postoperative complications, operating time, wound healing time, hospital stay, patient satisfaction and quality of life were evaluated. Results Postoperative pain scores were better in mucosal flap excision group than those in open excision group （P 〈 0.01 ）. The incidence of anal edema in mucosal flap excision group was lower than that in open excision group （P 〈 0.01 ） but no difference in other postoperative complications. There were no difference in operating time, wound healing time and hospital stay between two groups. Patient satisfaction scores were high in both groups with no significant differences（ 117.5 ±15.5, 112.5± 22）（P 〉 0.05 ）. Conclusion Short -term efficiency is better in mucosal flap excision group than that in open excision group. However, long -term outcomes require further study.

关 键 词：痔上黏膜环切术 直肠黏膜瓣切除 开放式切除 混合痔 

分 类 号：R657.19[医药卫生—外科学]