经多普勒痔动脉结扎及直肠肛管修复术治疗直肠粘膜内脱垂合并Ⅱ~Ⅲ度混合痔及对促炎因子的影响  

Influence of doppler-guided hemorrhoid artery ligation and rectal anal canal repair on proinflammatory factors in rectal intramucosal prolapse with mixed hemorrhoids of grade Ⅱ-Ⅲ

作　　者：郭志伟 唐迎春 翁霞惠 徐跃军 徐飞 车浩 陈艳 尚威 王恒 黄成龙 辜良刚 黄淦圣 Guo Zhiwei;Tang Yingchun;Weng Xiahui;Xu Yuejun;Xu Fei;Che Hao;Chen Yan;Shang Wei;Wang Heng;Huang Chenglong;Gu Lianggang;Huang Gansheng(Department of Hemorrhoids,Wuhan No.8 Hospital,Wuhan 430010,China)

机构地区：[1]武汉市第八医院肛肠科,430010

出　　处：《中华实验外科杂志》2020年第9期1739-1741,共3页Chinese Journal of Experimental Surgery

基　　金：武汉市卫生和计划委员会科研资助项目(WX17D34)。

摘　　要：目的观察经多普勒痔动脉结扎及直肠肛管修复术(DGHAL-RAR)治疗直肠黏膜内脱垂合并Ⅱ~Ⅲ度混合痔的临床疗效及对促炎因子白细胞介素(IL)-6、IL-17、肿瘤坏死因子-α(TNF-α)的影响。方法选取2017年10月至2018年12月武汉市第八医院肛肠科就诊的100例直肠黏膜内脱垂合并Ⅱ~Ⅲ度混合痔患者,数字法随机分为超声组(53例)与对照组(47例),超声组采用DGHAL-RAR术,对照组采用传统外剥内扎术,观察并统计两组手术前后的IL-6、IL-17、TNF-α水平变化及手术疗效、术后疼痛、术后恢复、并发症发生率等。结果超声组患者的手术时间、创面愈合时间、住院时间均显著短于对照组,术中出血量显著低于对照组(t=9.467、10.054、10.630、16.464,P<0.05);超声组患者术后的排便评分、排尿评分均显著低于对照组(t=11.634、18.448,P<0.05);超声组的手术总有效率为96.23%,对照组为95.74%,组间比较差异无统计学意义(χ^2=0.009,P>0.05);超声组的术后并发症总发生率为5.66%,显著低于对照组的21.28%(χ^2=5.371,P<0.05)。术前比较,两组术后1 d的IL-6、IL-17、TNF-α水平均较术前明显升高,术后3 d的IL-6、IL-17、TNF-α水平均较术后1 d明显降低,并且对照组术后1 d的升高幅度比超声组更明显,超声组术后1 d、术后3 d的IL-6、IL-17、TNF-α水平均显著低于对照组(t=4.851、4.958、8.652、5.033、4.874、3.995,P<0.05)。结论DGHAL-RAR术治疗直肠黏膜内脱垂合并Ⅱ~Ⅲ度混合痔的疗效确切,并且具有创伤小、疼痛轻、并发症风险低、术后恢复快的特点,临床应用优势显著。Objective To investigate the clinical effect of doppler-guided hemorrhoid artery ligation and recto-anal canal repair(DGHAL-RAR)in the treatment of rectal mucosal prolapse combined with mixed hemorrhoids of degreeⅡ-Ⅲand its influence on proinflammatory factors interleukin(IL)-6,IL-17 and tumor necrosis factor-α(TNF-α).Methods 100 cases of rectal mucosal prolapse combined with mixed hemorrhoids of degreeⅡtoⅢwere selected from our anorectal department between October 2017 and December 2018,and divided into two groups according to random number method:ultrasound group(53 cases)and control group(47 cases).The two groups respectively were treated with DGHAL-RAR and traditional stripping and internal ligation.The changes of IL-6,IL-17 and TNF-αlevels before and after operation,the efficacy of operation,postoperative pain,recovery and complications were investigated and statistics.Results The operation time,wound healing time and hospitalization time were significantly shorter,and the amount of bleeding during operation was significantly lower in the ultrasound group than those the control group(t=9.467,10.054,10.630,16.464,P<0.05).The defecation score and urination score in the ultrasound group were significantly lower than those in the control group(t=11.634,18.448,P<0.05).The total effective rate in the ultrasound group and control group was 96.23%and 95.74%respectively(χ^2=0.009,P>0.05).The total incidence of postoperative complications in the ultrasound group and control group was 5.66%and(21.28%,χ^2=5.371,P<0.05).The levels of IL-6,IL-17 and TNF-αwere significantly higher in the two groups on the 1st day after operation than those before operation.The levels of IL-6,IL-17 and TNF-αon the 3rd day after operation were significantly lower than those on the 1st day after operation in the control group.The levels of IL-6,IL-17 and TNF-αon the 1st day and 3rd day after operation in the ultrasound group were significantly lower than those in the control group(t=4.851,4.958,8.652,5.033,4.874,3.995,P<0.05).

关 键 词：直肠黏膜内脱垂 混合痔 超声引导 痔动脉结扎术 促炎因子 

分 类 号：R657.1[医药卫生—外科学]