分段内括约肌切断加分段外剥内扎术治疗环状混合痔的临床疗效观察  

Segmental internal sphincterotomy combined with segmental Milligan-Morgan hemorrhoidectomy for circumferential mixed hemorrhoids

作　　者：张瑞芳[1] 陈红霞[1] 陈林[1] 范永强[1] 李一雄 陈朝晖[1] Zhang Ruifang;Chen Hongxia;Chen Lin;Fan Yongqiang;Li Yixiong;Chen Chaohui(Department of Integrated Traditional Chinese and Western Medicine,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,Sichuan,China)

机构地区：[1]成都医学院第一附属医院中西医结合科,四川成都610500

出　　处：《结直肠肛门外科》2021年第1期40-44,共5页Journal of Colorectal & Anal Surgery

基　　金：四川省教育厅科研项目(17ZA0129)。

摘　　要：目的探讨分段内括约肌切断加分段外剥内扎术治疗环状混合痔的临床疗效。方法纳入2019年1月至2019年12月成都医学院第一附属医院中西医结合科收治的120例环状混合痔住院患者为研究对象。将研究对象随机分为治疗组(采用分段内括约肌切断加分段外剥内扎术,n=60)和对照组(采用分段外剥内扎术,n=60)。比较两组患者的肛门疼痛程度、直肠肛管测压指标(肛管静息压、肛管最大收缩压、肛管舒张压)、肛门切口水肿程度、肛门功能、疗效及切口愈合时间。结果两组患者术后24 h的肛门VAS疼痛评分、术前直肠肛管测压指标(肛管静息压、肛管最大收缩压、肛管舒张压)及术后肛门Wexner评分(术后第7天、1个月及3个月)比较差异均无统计学意义(均P>0.05);治疗组首次排粪、术后第7天及术后第14天的肛门VAS疼痛评分低于对照组,术后1个月和术后3个月的肛管静息压高于对照组,术后第7天、1个月及3个月的肛门切口水肿评分低于对照组,术后1个月的肛门狭窄程度轻于对照组,术后切口愈合时间短于对照组,差异均有统计学意义(均P<0.05)。治疗组治愈率为95%,对照组治愈率为91.7%,两组患者治愈率比较,差异无统计学意义(P>0.05)。结论分段内括约肌切断加分段外剥内扎术治疗环状混合痔可减轻患者术后肛门疼痛程度、切口水肿严重程度及肛门狭窄程度,并可缩短切口愈合时间,值得临床推广应用。Objectives To investigate the effect of segmental internal sphincterotomy combined with segmental Milligan-Morgan hemorrhoidectomy for circumferential mixed hemorrhoids.Methods One hundred and twenty patients with circumferential mixed hemorrhoids treated at the Department of Integrated Traditional Chinese and Western Medicine,The First Affiliated Hospital of Chengdu Medical College,were recruited between January and December 2019.Patients were randomly assigned to the treatment group(receiving segmental internal sphincterotomy combined with segmental Milligan-Morgan hemorrhoidectomy,n=60)and the control group(receiving segmental Milligan-Morgan hemorrhoidectomy,n=60).Anal pain,anorectal manometry measurements(resting anal pressure,maximum anal squeeze pressure,and diastolic pressure),anal incision edema,anal function,overall effectiveness,and wound healing time were compared between the two groups.Results The two groups did not differ in anal pain visual analog scale(VAS)at 24 hours after surgery,pre-surgery anorectal manometry measurements(resting anal pressure,maximum anal squeeze pressure,and diastolic pressure),and postoperative Wexner scores at 7 days,1 month,and 3 months after surgery(P>0.05).Compared with the control group,the treatment group had significantly less anal pain at the first bowel movement,7 days,and 14 days after surgery,significantly higher anal resting pressure at 1 month and 3 months after surgery,significantly less anal incision edema at 7 days,1 month,and 3 months after surgery,significantly less severity of anal stricture at 1 month after surgery,and significantly shorter wound healing time(P<0.05).Overall effectiveness was 95%in the treatment group and 91.7%in the control group,with no significant difference between the two groups(P>0.05).Conclusion For patients with circumferential mixed hemorrhoids,segmental internal sphincterotomy combined with segmental Milligan-Morgan hemorrhoidectomy can alleviate postoperative anal pain,anal incision edema,and severity of anal stricture.It can

关 键 词：环状混合痔 分段内括约肌切断术 分段外剥内扎术 

分 类 号：R657.18[医药卫生—外科学]