自动弹力线痔疮套扎术联合外痔切除保留齿状线术治疗混合痔临床疗效及对患者疼痛应激肛肠动力学的影响  

Efficacy of automatic ligation of hemorrhoids combined with external hemorrhoidectomy with retained dentate line on mixed hemorrhoids and its effects on pain stress and anorectal dynamics

作　　者：乔新新 詹成 吴昌旭 Qiao Xinxin;Zhan Cheng;Wu Changxu(Pingmei Shenma Medical Group General Hospital,Pingding shang 467000,Henan,China)

机构地区：[1]平煤神马医疗集团总医院,河南平顶山467000

出　　处：《临床心身疾病杂志》2020年第3期64-67,119,共5页Journal of Clinical Psychosomatic Diseases

基　　金：平顶山市科技计划项H(编号201700216)。

摘　　要：目的探讨自动弹力线痔疮套扎术联合外痔切除保留齿状线术治疗混合痔的临床疗效及对患者疼痛应激、肛肠动力学的影响.方法将106例混合痔患者按随机数字表法分为两组,各53例.对照组予以外剥内扎术治疗,观察组予以自动弹力线痔疮套扎术联合外痔切除保留齿状线术治疗,术后随访1个月.比较两组临床疗效及患者术后疼痛应激、肛肠动力学指标,统计两组并发症发生情况.结果(1)两组总有效率均为100%.(2)观察组手术时间、住院时间显著短于对照组(P<0.01),术中出血量显著少于对照组(P<0.01),创面愈合时间显著早于对照组(P<0.01).(3)术后1 d、3 d、7 d末两组视觉模拟法评分及血清前列腺素E2、P物质及神经肽Y水平呈明显下降趋势(P<0.05),术后各时间点间比较差异有统计学意义(P<0.05);观察组显著低于对照组(P<0.05).(4)术后1个月末两组直肠静息压及直肠肛管抑制反射阈值较术前显著升高(P<0.01),肛管最大收缩压较术前显著降低(P<0.01),观察组直肠静息压及直肠肛管抑制反射阈值显著高于对照组(P<0.01),肛管最大收缩压显著低于对照组(P<0.01).(5)观察组术后排尿困难及术后并发症总发生率显著低于对照组(P<0.05).结论自动弹力线痔疮套扎术联合外痔切除保留齿状线术治疗混合痔成功率较高,有利于减轻疼痛应激反应水平,改善肛门动力学指标,安全性高.Objective To study the efficacy of automatic ligation of hemorrhoids combined with external hemorrhoidectomy with retained dentate line on mixed hemorrhoids and its effects on pain stress and anorectal dynamics.Methods 106 patients with mixed hemorrhoids were divided into two groups according to the random number table method,with 53 cases in each group.Control group was treated with milliganmorgan hemorrhoidectomy,and observation group was given RPH combined external hemorrhoidectomy with retained dentate line.Patients were followed up for 1 month.The clinical efficacy and postoperative pain stress,anorectal dynamics,and complications of the two groups were compared.Results(1)The total effective rate of both groups was 100%.(2)The operation time and hospital stay of the observation group were significantly shorter than those of the control group(P<0.01),the intraoperative blood loss was significantly less than that of the control group(P<0.01),and the wound healing time was significantly earlier than that of the control group(P<0.01).(3)The VAS scores and levels of serum PGE2,SP and NPY in the two groups were significantly decreased at 1 d,3 d and 7 d after surgery(P<0.05),and the differences were statistically significant at each time point after surgery(P<0.05),the observation group was significantly lower than the control group(P<0.05).(4)At 1 month after surgery,the RRP and AIRT in the two groups were significantly increased(P<0.05)while the MSP was significantly decreased(P<0.05),and the RRP and AIRT in observation group were higher than those in control group while the MSP was lower than that in control group(P<0.01).(5)The incidence rate of postoperative dysuria in observation group was significantly lower than that in control group(P<0.05).Conclusions RPH combined with external hemorrhoidectomy with retained dentate line has a higher success rate of mixed hemorrhoids,and it is beneficial to reduce pain stress,improve indexes of anal dynamics,and have high safety.

关 键 词：混合痔 自动弹力线痔疮套扎术 外痔切除保留齿状线术 疼痛 肛肠动力学 

分 类 号：R657.1[医药卫生—外科学]