改良绑缚闭合术治疗老年重度混合痔的临床研究  

Clinical Study of Modified Hemorrhoidectomy and Suspensory Ligation in the Treatment of Severe Mixed Hemorrhoids in Elderly Patients

作　　者：陶晓春[1] 周清 梁宏涛[1] 王琛[1] Tao Xiaochun;Zhou Qing;Liang Hongtao;Wang Chen(Anorectal Department,Longhua Hospital,Shanghai University of Traditional ChineseMedicine,Shanghai,200032,P.R.China;Anorectal Department,Central Hospital of Minhang District,Shanghai,201100,P.R.China)

机构地区：[1]上海中医药大学附属龙华医院肛肠科,上海200032 [2]上海市闵行区中心医院肛肠科,上海201100

出　　处：《老年医学与保健》2020年第6期1046-1049,1059,共5页Geriatrics & Health Care

基　　金：全国中医学术流派传承工作室第二轮建设项目(国中医药人教函[2019]62号);上海中医药大学附属龙华医院爱建捐赠基金(AJ016);上海中医药大学附属龙华医院优秀青年人才临床能力提升计划(第二批)。

摘　　要：目的观察改良绑缚闭合术治疗老年重度混合痔的临床疗效,为治疗该病提供参考。方法选择2017年7月-2019年8月在上海中医药大学附属龙华医院肛肠科住院的初次手术治疗的老年重度混合痔患者60例,随机分为观察组和对照组,每组30例。观察组采用改良绑缚闭合术,对照组采用痔上黏膜环切钉合联合外痔切除术。以术后创面愈合时间、治愈率为主要疗效评价指标;以复发率、术后并发症程度(水肿、疼痛、出血、坠胀等症状)、生活质量量表(SF-12)评估等为次要疗效评价指标;以治疗费用为卫生经济学指标,评估并比较2组上述指标测得值。结果观察组术后创面愈合时间明显少于对照组(P<0.05),但2组间治愈率差异无统计学意义(P>0.05)。观察组术后水肿、疼痛、出血、坠胀评分均明显低于对照组(P<0.05),而SF-12评分明显高于对照组(P<0.05),提示观察组患者的症状和生活质量比对照组患者改善更加明显;随访6个月,观察组无复发病例,对照组有1例复发脱出,但2组复发率差异无统计学意义(P>0.05)。观察组住院费用明显少于对照组(12335.37±1070.44元vs17656.39±1651.35元,P<0.05)。2组均无不良事件发生。结论改良绑缚闭合术治疗老年重度混合痔,疗效确切,操作简便,经济安全。Objective To observe the clinical effect of modified hemorrhoidectomy and suspensory ligation in the treatment of severe mixed hemorrhoids in elderly patients and provide reference for the treatment of this disease.Methods From July 2017 to August 2019,60 elderly patients with severe mixed hemorrhoids who were hospitalized for the first time in the Anorectal Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected and divided randomly into observation group and control group,with 30 cases in each group.The observation group was treated with modified hemorrhoidectomy and suspensory ligation,while the control group was treated with procedure for prolapse and hemorrhoids(PPH)with external hemorrhoidectomy.The wound healing time and cure rate were used as the main efficacy evaluation indexes;the recurrence rate,postoperative complications(edema,pain,bleeding,swelling and other symptoms)and the quality of life scale(SF-12)score were used as the secondary efficacy evaluation indexes;the treatment expense was used as the health economic index.The above indexes were evaluated and compared between the two groups.Results The wound healing time of the observation group was significantly shorter than that of the control group(P<0.05),but there was no significant difference in the cure rate between the two groups(P>0.05).The scores of edema,pain,bleeding and swelling of the observation group were significantly lower than those of the control group(P<0.05),while the SF-12 score was significantly higher than that of the control group(P<0.05).Followed up for 6 months,there was no recurrence in the observation group,and one relapse in the control group,but the difference in recurrence rate between the two groups was not statistically significant(P>0.05).The treatment expense of the observation group were significantly less than that of the control group(12335.37±1070.44 Yuanvs 17656.39±1651.35 Yuan,P<0.05).No adverse events occurred in both groups.Conclusion The modified hem

关 键 词：老年 混合痔 绑缚闭合术 临床疗效 生活质量 

分 类 号：R657.18[医药卫生—外科学]