选择性痔上黏膜切除术与吻合器痔上黏膜环切术治疗Ⅲ度和Ⅳ度痔的疗效比较  

Comparison of curative effect between tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids for stage III and IV hemorrhoids

作　　者：王守练[1] 郑林海 倪晓春[1] 吴巨钢[1] 朱登峰 姜波健[1] 俞继卫[1] Wang Shoulian Zheng Linhai Ni Xiaochun Wu Jugang Zhu Dengfeng(Department of General Surgery, Shanghai Ninth People＇s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China)

机构地区：[1]上海交通大学医学院附属第九人民医院普外科,上海201999 [2]上海交通大学医学院附属新华医院崇明分院普外科,上海201999

出　　处：《国际外科学杂志》2017年第8期535-538,共4页International Journal of Surgery

摘　　要：目的分析比较选择性痔上黏膜切除术与吻合器痔上黏膜环切术在Ⅲ、Ⅳ痔疮患者中的治疗效果。方法收集2013年1月-2014年6月于上海交通大学医学院附属第九人民医院和上海交通大学医学院附属新华医院（崇明分院）普外科行选择性痔上黏膜切除术和吻合器痔上黏膜环切术手术的Ⅲ、Ⅳ痔疮患者，运用￡检验比较两组患者在手术时间、术中出血、术后住院时间、恢复日常工作时间等围手术期相关变量的差异，术后的疼痛程度和出血、尿潴留、急便感、大便失禁、肛门狭窄及直肠阴道瘘的发病率和复发率则通过t检验或，检验进行比较，运用秩和检验比较两组患者满意度差异。结果吻合器痔上黏膜环切术组手术时间、术中出血量评分、术后住院时间及恢复日常工作时间均显著高于选择性痔上黏膜切除术组（P=0．021，P=0．003，P=0．001，P〈0．001）；吻合器痔上黏膜环切术组在术后第一次排便和术后24h、72h的疼痛评分均显著高于选择性痔上黏膜切除术组（均P〈0．001）；吻合器痔上黏膜环切术组术后1个月内存在急便感的患者比例（18．6％）明显高于选择性痔上黏膜切除术组（6．6％）（P=0．036）；两组患者术后出血、尿潴留的发病率及复发率、患者满意度评价等方面差异无统计学意义（P〉0．05）。结论选择性痔上黏膜切除术在手术时间、术中出血量、术后疼痛及术后急便感的发病率等方面明显优于吻合器痔上黏膜环切术手术，且其长期疗效可达到与吻合器痔上黏膜环切术相当的水平。Objective To compare the curative effect of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of patients with stage III to IV hemorrhoids. Methods The patients with stage III to IV hemorrhoids who underwent prolapse and hemorrhoids or tissue-selecting therapy stapler surgery in the department of General Surgery, Shanghai Ninth People＇s Hospital and Xinhua Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, from Jan. 2013 to Jun. 2014 were accepted and allocated to prolapse and hemorrhoids or tissue-selecting therapy stapler group. The peri-operative parameters about operative time, blood loss, postoperative hospital stay and the time required to return to normal activity were compared by t test, The postoperative complications including pain assessment and the incidence of postoperative bleeding, urine retention, faecal urgency, fecal incontinence, anal stenosis, rectovaginal fistula and recurrence rate were compared by t test and chi-square test. Rank sum test was used to compare the recurrence rate and patient~ satisfaction between the two groups. Results The operation time, intraoperative bleeding volum, postoperative hospital stay and the time required to return to normal activity in the procedure for prolapse and hemorrhoids group were signifeantly higher than those in the tissue-selecting therapy stapler group （P = 0. 021, P = 0. 003, P = 0. 001 , P 〈 0. 001 ）. The pain score of procedure for prolapse and hemorrhoids group were all higher than those of the tissue-selecting therapy stapler group in the first post-operative defecation and in post-operative 24 hours and 72 hours （all P 〈 0.001 ）. The incidence of faecal urgency of the procedure for prolapse and hemorrhoids group in post-operative 1 month （18.6%） was higher than that of the tissue-selecting therapy stapler group （6.6%） （P = 0. 036 ）. There were no statistically significant differences in the incidence of postoperative bleeding, urina

关 键 词：痔 治疗结果 卡方分布 混合痔 吻合器痔上黏膜环切术 选择性痔上黏膜切除术 

分 类 号：R657.18[医药卫生—外科学]