PPH联合部分肛门内括约肌切断术对重度混合痔术后创缘水肿及肛门功能的影响  

Effects of PPH combined with partial internal anal sphincterotomy on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids

作　　者：李昌权[1] 钱腊燕 李岗[1] 史伟[1] 季恩敏[1] LI Changquan;QIAN Layan;LI Gang;SHI Wei;JI Enmin(Department of Gastrointestinal Surgery,Bozhou People’s Hospital,Bozhou,Anhui 236800,P.R.China)

机构地区：[1]亳州市人民医院胃肠外科,安徽亳州236800

出　　处：《中国普外基础与临床杂志》2020年第5期574-578,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨吻合器痔上黏膜环切术(PPH)联合部分肛门内括约肌切断术(简称"PPH+切断术")对重度混合痔术后创缘水肿及肛门功能的影响。方法选取笔者所在医院2017年2月至2018年2月期间收治的重度混合痔患者85例作为研究对象,根据治疗方式的不同分为PPH组(42例)和PPH+切断术组(43例),其中PPH组仅采用PPH治疗,PPH+切断术组在PPH治疗基础上配合部分肛门内括约肌切断术治疗。观察2组患者治疗后的临床疗效、疼痛程度、创缘水肿、肛门功能情况及术后症状复发情况。结果(1)2组患者基线资料如性别、年龄、病程、内痔分度及症状比较差异无统计学意义(P>0.05)。(2)PPH+切断术组患者的治疗总有效率明显高于PPH组[100%(43/43)比90.48%(38/42),χ^2=4.297,P=0.038]。(3)在治疗后第3和7天时PPH+切断术组患者的VAS评分均明显低于PPH组(P<0.05);每组患者在治疗后第3和7天时的VAS评分均较治疗前明显降低(P<0.05)且治疗后第7天时明显低于第3天(P<0.05)。(4)PPH组术后创缘水肿情况明显较PPH+切断术组严重(χ^2=20.237,P<0.001),且PPH组术后创缘水肿评分明显高于PPH+切断术组(t=13.514,P<0.001)。(5)治疗后,2组患者肛管静息压比治疗前降低(P<0.05)、肛管舒张压较治疗前有所升高(P<0.05);且治疗后PPH+切断术组肛管静息压低于PPH组(P<0.05)、肛管舒张压高于PPH组(P<0.05)。(6)PPH+切断术组患者术后1年时症状总复发率明显低于PPH组[6.98%(3/43)比23.81%(10/42),χ^2=4.647,P=0.031]。结论PPH+切断术治疗可有效缓解重度混合痔患者的症状,提高临床疗效,降低复发率。Objective To explore the effects of procedure for prolapse and hemorrhoids(PPH)combined with partial internal anal sphincterotomy(Abbreviation:PPH+sphincterotomy)on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids.Methods Eighty-five patients with severe mixed hemorrhoids admitted to this hospital from February 2017 to February 2018 were selected as the study subjects,then they were divided into a PPH group(n=42)and PPH+sphincterotomy group(n=43)according to the different treatment methods.The patient in the PPH group was treated with the PPH,while in the PPH+sphincterotomy group was treated with the partial internal anal sphincterotomy on the basis of the PPH group.The clinical efficacy,degree of pain,edema of wound margin,anal function,and the recurrence rate of symptoms were observed in two groups.Results(1)There were no significant differences in the baseline data such as the gender,age,course of disease,grading of internal hemorrhoids,and symptoms between the two groups(P>0.05).(2)The total effective rate of the PPH+sphincterotomy group was significantly higher than that of the PPH group[100%(43/43)versus 90.48%(38/42),χ^2=4.297,P=0.038].(3)The VAS score of the PPH+sphincterotomy group was significantly lower than that of the PPH group on the 3rd and 7th day after the treatment(P<0.05),the VAS score of each group at the 3rd or 7th day after the treatment was significantly lower than that before the treatment(P<0.05),and it was significantly lower on the 7th day than that on the 3rd day after the treatment(P<0.05).(4)The postoperative wound margin edema in the PPH group was more serious than that in PPH+sphincterotomy group(χ^2=20.237,P<0.001),and the score in the PPH group was significantly higher than that in the PPH+sphincterotomy group(t=13.514,P<0.001).(5)The resting pressure of anal canal after the treatment was significantly lower than that before treatment(P<0.05),and the diastolic pressure of anal canal after the treatment was significantly higher than th

关 键 词：吻合器痔上黏膜环切术 部分肛门内括约肌切断术 重度混合痔 创缘水肿 肛门功能 

分 类 号：R657.18[医药卫生—外科学]