中重度混合痔的术式选择及疗效对比  

Choice of Operation Method and the Comparison of Curative Effect of Moderate and Severe Mixed Hemorrhoids

作　　者：赵敏[1] 桑畅野 闫长红[1] 王燕鹏[1] 王洋[1] ZHAO Min;SANG Changye;YAN Changhong;WANG Yanpeng;WANG Yang(Department of General Surgery,Yanqing District Hospital of Beijing City(Peking University Third Hospital Yanqing Hospital),Beijing102100,China)

机构地区：[1]北京市延庆区医院(北京大学第三医院延庆医院)普外科

出　　处：《宁夏医科大学学报》2019年第9期939-943,共5页Journal of Ningxia Medical University

基　　金：北京市优秀人才培养计划资助项目(YQRC2018-0205)

摘　　要：目的对比传统外剥内扎术(传统组)、自动痔疮套扎术(RPH)+外痔切除术(RPH组)、吻合器痔上黏膜环切术(PPH)+外痔切除术(PPH组)与治疗中重度混合痔的临床效果,旨在为临床选择合理的治疗方案提供依据。方法选取2016年4月—2019年1月间本院收治、且病例资料完整、分别行上述三种术式治疗的患者各50例,分析三种术式的手术用时、术中出血量、住院时间、恢复时间、术后并发症及临床疗效。结果RPH组、PPH组术中出血量、手术用时、创面恢复时间及住院时间均少于传统组(P均<0.05);RPH组术中出血量、手术用时、创面恢复时间及住院时间均低于PPH组(P均<0.05);RPH组、PPH组术后第1天、首次排便及术后1周时VAS评分均低于传统组(P均<0.05);RPH组首次排便时VAS评分低于PPH组(P<0.05);RPH组、PPH组患者术后出血、肛周水肿发生率均低于传统组(P均<0.05);RPH组术后尿潴留发生率低于传统组(P<0.05);RPH组、PPH组痊愈率均高于传统组(P均<0.05),但两组间痊愈率差异无统计学意义(P>0.05)。结论RPH+外痔切除术、PPH+外痔切除术均可有效治疗中重度混合痔,但RPH+外痔切除术在术中创伤及术后康复方面较PPH+外痔切除术有一定优势,应优先选用。Objective To compare the clinical efficacy of the traditional Milligan-morgan hemorrhoids(traditional group),RPH+external hemorrhoidectomy(RPH group),and PPH+external hemorrhoidectomy(PPH group)in the treatment of the moderate and severe mixed hemorrhoids in order to provide an evidence for the selection of rational treatment protocols.Methods A total of 50 patients who were admitted in our hospital from April,2016 to January,2019 for the above three surgical methods with complete case materials were included in the study.The operation time,intraoperative amount of bleeding,hospitalization time,recovery time,postoperative complications,and clinical efficacy in the three groups were compared and analyzed.Results The intraoperative amount of bleeding,operation time,wound recovery time,and hospitalization time in RPH group and PPH group were significantly less than those in the traditional group(P all<0.05).The intraoperative amount of bleeding,operation time,wound recovery time,and hospitalization time in RPH group were significantly lower than those in PPH group(P all<0.05).VAS scores 1d after operation,for the first defecation,and 1 week after operation in RPH group and PPH group were significantly lower than those in the traditional group(P all<0.05).VAS score for the first defecation in RPH group was significantly lower than that in PPH group(P<0.05).The occurrence rate of postoperative bleeding,and perianal edema in RPH group and PPH group was significantly lower than that in the traditional group(P all<0.05).The occurrence rate of postoperative urine retention in RPH group was significantly lower than that in the traditional group(P<0.05).The healing rate in RPH group and PPH group was significantly higher than that in the traditional group(P all<0.05),but the comparison between the two groups was not significantly different(P>0.05).Conclusion Both RPH+external hemorrhoidectomy and PPH+external hemorrhoidectomy can effectively treat the moderate and severe mixed hemorrhoids,but RPH+external hemorrhoidectomy h

关 键 词：中重度混合痔 自动痔疮套扎术 吻合器痔上黏膜环切术 外痔切除术 外剥内扎术 

分 类 号：R657.18[医药卫生—外科学]