基于齿状线保护的TST+分段外痔切除术治疗重度环状混合痔的临床效果观察  

Clinical effect obsenation of dentate-line-preserving tissue-selecting technique combined with segmental hemorrhoidectomy for severe circumferential mixed hemorrhoids

作　　者：李天煜 蔡伟杰 陆浩林 陈耀坤 蔡社兴 许家榕 Li Tianyu;Cai Weijie;Lu Haolin;Chen Yaokun;Cai Shexing;Xu Jiarong(Department of Surgery, Guangdong Medical University, Dongguan 523808, Guangdong, China;Departmentof Anorectal Surgery, Dongguan Dalang Hospital, Dongguan 523770, Guangdong, China)

机构地区：[1]广东医科大学外科学教研室,广东东莞523808 [2]东莞市大朗医院肛肠外科,广东东莞523770

出　　处：《结直肠肛门外科》2019年第5期548-552,共5页Journal of Colorectal & Anal Surgery

基　　金：东莞市社会科技发展项目（2017507152461,2015105101261,201750715040096）;广东医科大学大学生创新创业训练计划项目（GDMU2016062）

摘　　要：目的观察选择性痔上黏膜切除钉合术(TST)+分段外痔切除保留齿状线术治疗重度环状混合痔的临床效果。方法纳入2016年1月至2018年1月东莞市大朗医院肛肠外科收治的60例重度环状混合痔患者为研究对象,按随机数字表法将患者分为两组,治疗组(n=30)采用TST+分段外痔切除保留齿状线术,对照组(n=30)采用外剥内扎术。观察记录两组手术时间、术中出血量、住院时间、治疗效果及术后并发症发生情况。结果两组手术时间、术中出血量及平均住院时间比较,差异均无统计学意义(均P>0.05);治疗组痊愈率高于对照组,差异有统计学意义(P<0.001),且治疗组治疗效果优于对照组,差异有统计学意义(P<0.05);两组术后疼痛评分及尿潴留、肛门异物感及肛门狭窄发生率比较,差异均无统计学意义(均P>0.05),治疗组术后出血及肛缘水肿评分均低于对照组(均P<0.05),治疗组术后皮赘残留及排便困难发生率低于对照组(均P<0.05)。结论TST+分段外痔切除保留齿状线术治疗重度环状混合痔具有疗效好、痊愈率高、排便功能恢复良好、肛缘水肿轻、外观美观等优点,值得基层临床推广。Objectives To investigate the effect of dentate-line-preserving tissue-selecting technique (TST) combined with seg mental hemorrhoidectomy in treating severe circumferential mixed hemorrhoids. Methods Sixty patients with severe circumferen tial mixed hemorrhoids treated between January 2016 and January 2018 at the Department of Anorectal Surgery at Dongguan Dalang Hospital were recruited. Patients were randomly assigned to treatment group and control group. Treatment group (n = 30) received TST combined with segmental hemorrhoidectomy, and control group (n = 30) received Milligan-Morgan hemorrhoidecto my. The following were recorded: duration of surgery, intraoperative blood loss, duration of hospitalization, effectiveness, and inci dence of postoperative complications. Results There was no significant difference between the groups in duration of surgery, in traoperative blood loss, and duration of hospitalization (P > 0.05). Cure rate and effectiveness were significantly higher in the treatment group than in the control group (P < 0.05). Postoperative pain scores and incidence of urinary retention, foreign body sensation, and anal stricture were similar between groups (P > 0.05). The incidence of postoperative bleeding, anal swelling, resid ual skin tags, and defecation difficulty was significantly lower in the treatment group (P < 0.05). Conclusion Dentate-line-pre serving TST combined with segmental hemorrhoidectomy is effective in treating severe circumferential mixed hemorrhoids. It is as sociated with high cure rate, better defecation function, mild anal swelling, and aesthetics.

关 键 词：重度环状混合痔 TST 分段外痔切除术 外剥内扎术 临床疗效 

分 类 号：R657.1[医药卫生—外科学]