RPH联合改良外切内扎术治疗老年混合痔的效果及患者应激情况观察  

Curative effect and stress reaction of RPH combined with improved Milligan-Morgan surgery in elder patients with mixed hemorrhoids

作　　者：沈伟[1] 鞠玉林[1] 胡占岭[1] 

机构地区：[1]沈阳市肛肠医院肛门病科,辽宁沈阳110000

出　　处：《结直肠肛门外科》2017年第6期759-763,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨痔自动套扎术(RPH)联合改良外切内扎术治疗老年混合痔的近期疗效及患者术后发生应激反应的情况。方法将本院80例老年混合痔患者随机均分为观察组(RPH联合改良外切内扎术)与对照组[痔上黏膜环型切除术(PPH)联合改良外切内扎术],对比两组手术相关指标(手术时间、术中出血量、创面愈合时间、便中带血时间、肛周水肿时间、住院时间)、应激指标[C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)、皮质醇(COR)]变化、肛门功能、术后并发症发生率。结果观察组术中出血量低于对照组,创面愈合时间、便中带血时间、肛周水肿时间短于对照组(P<0.05)。两组术前、术后12 h、术后24 h CPR、ACTH、COR依次呈递增趋势(P<0.05);观察组术后12 h、术后24 h各应激指标均显著低于对照组(均P<0.05)。两组手术前后肛管静息压、肛管最大收缩压比较均无显著差异(均P>0.05)。观察组术后Wexner评分明显低于对照组(P<0.05)。观察组并发症发生率显著低于对照组(P<0.05)。结论 RPH联合改良外切内扎术治疗老年混合痔创伤小,患者应激反应较轻,能较好地保护肛垫组织,降低术后并发症发生率,临床应用价值较高。Objective To study the curative effect and stress reaction of automatic ligation of hemorrhoids（RPH） combined with improved Milligan-Morgan surgery in the treatment of elder patients with mixed hemorrhoids.Methods 80 elder patients with mixed hemorrhoids who were treated in our hospital were randomly assigned to treatment group（RPH combined with modified Milligan-Morgan surgery） and control group（Hemorrhoid mucosal ring excision（PPH） combined with improved Milligan-Morgan surgery）. The parameters related to operation（the operation time, intraoperative bleeding, wound healing time, duration of hematochezia, duration of perianal edema, duration of hospitalization）, stress indices（ levels of CRP, ACTH, and COR）, anal function and postoperative complications were compared between the two groups. Results Intraoperative blood loss in the treatment group was fewer than that in the control group. Wound healing time, duration of hematochezia, and duration of perianal edema were shorter than those in the control group（P 〈0.05）. The CPR, ACTH and COR levels preoperative, 12 h postoperative and 24 h postoperative showed an increasing trend in both groups（P 〈0.05）. The stress indices 12 h postoperative and postoperative 24 h in the treatment group were significantly lower than those in the control group（P 〈0.05）. There was no significant difference in anal rest pressure and anal maximum systolic pressure between the two groups（P 〉0.05）. The Wexner score in the treatment group was lower than that in the control group（P〈 0.05）. The complication rate in the treatment group was lower than that in the control group（P 〈0.05）.Conclusion RPH combined with improved Milligan-Morgan surgery can shorten healing time, duration of hematochezia, and duration of perianal edema, and reduce the amount of bleeding in the treatment of mixed hemorrhoids in elder patients. It can also relieve stress, protect the anal pad tissue to the greatest extent and reduce the postoperative complicat

关 键 词：RPH 改良外切内扎术 老年 混合痔 

分 类 号：R657.18[医药卫生—外科学]