超选择直肠上动脉栓塞术(SRAE)与吻合器痔上黏膜环切钉合术(PPH)治疗痔的回顾性研究  

A retrospective study of super-selective superior rectal artery branch embolization(SRAE)and procedure of prolapse and hemorrhoids(PPH)

作　　者：顾雪萍[1] 孙玲芳[2] GU Xue-ping;SUN Ling-fang(Department of Intervention Center,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China;Department of Intervention Center,The First Affiliated Hospital of Soochow University,Suzhou 215001,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院介入中心,苏州215004 [2]苏州大学附属第一医院介入中心,苏州215001

出　　处：《复旦学报（医学版）》2020年第2期275-279,292,共6页Fudan University Journal of Medical Sciences

摘　　要：目的回顾性比较超选择直肠上动脉栓塞术(super-selective superior rectal artery branch embolization,SRAE)与吻合器痔上黏膜环切钉合术(procedure for prolapse and hemorrhoids,PPH)的疗效、围手术期安全性和预后。方法回顾性分析2017年6月—2018年12月苏州大学附属第二医院进行的37例SRAE和60例PPH患者,对比分析两组手术时间、出血量、血常规指标、住院时间、住院费用、切口感染出血、术后出血、术后疼痛发热、术后肛管狭窄、便秘发生、抗生素使用及12个月随访结果等情况。结果SRAE组患者年龄更高(P=0.009),多伴有更多高血压、糖尿病及心功能不全(P<0.001),手术时间短,术中出血量少,术后疼痛轻微、出血少,术后发热少、使用抗生素少,无术后肛管狭窄发生,住院时间短(P<0.001),但住院费用较PPH组高(P<0.001)。两组术后便秘发生率(P=0.067)、术前和术后血常规(P=0.154,P=0.278)差异无显著统计学意义。采用术后痔复发或再次手术作为联合终点,经Kaplan-Meier曲线联合Log-rank检验结果显示两组差异无显著统计学意义(P=0.56)。结论SRAE治疗痔安全可靠,在减少感染出血和术后疼痛等并发症方面较PPH有明显优势,但远期效果并不优于临床上其他常规的微创手术。因此,SRAE仅为高危患者提供了一个有益的治疗选择。Objective To compare the efficacy,safety and prognosis of super-selective superior rectal artery branch embolization(SRAE)and procedure for prolapse and hemorrhoids(PPH).Methods A retrospective analysis was performed on 37 cases of SRAE and 60 cases of PPH in our hospital from June 2017 to December 2018.Patients were followed up for 12 months and compared the operation time,blood volume,hemoglobin index,hospitalization time,hospitalization cost,incision infection and bleeding,postoperative pain and fever,anal canal stenosis,constipation,antibiotic use,and disease recurrence.Results Patients in the SRAE group were older(P=0.009),with more cases of hypertension,diabetes and cardiac insufficiency(P<0.001).The SARE group had shorter operation time,less intraoperative blood loss,less postoperative pain,less bleeding,less postoperative fever,less antibiotics after surgery,no postoperative anal stenosis,and shorter hospital stay(P<0.0001),but hospitalization costs were higher than PPH group(P<0.0001).There was no difference in the incidence of postoperative constipation(P=0.067)between the two groups and preoperative and follow-up hemoglobin index(P=0.154;P=0.278).The postoperative delirium recurrence or reoperation was used as the combined end point.Kaplan-Meier curve combined with Log-rank test showed no significant difference between the two groups(P=0.56).Conclusion SRAE is safe and reliable,and it has obvious advantages over PPH in reducing complications such as bleeding and postoperative pain.Compared with conventional minimally invasive surgery,the long-term effect of SRAE is not ideal,but it provides a beneficial option,especially for high-risk patients.

关 键 词：痔 超选择直肠上动脉栓塞术(SRAE) 吻合器痔上黏膜环切钉合术(PPH) 

分 类 号：R657.18[医药卫生—外科学]