痔动脉结扎+悬吊缝合+缚扎固定+皮桥整形术治疗环状脱垂性混合痔的临床观察  

Combining hemorrhoidal artery ligation,suspension suture,binding fixation,and skin bridge anoplasty for circumferential prolapsing mixed hemorrhoids

作　　者：郭其乐 姚向阳 王琛 Guo Qile;Yao Xiangyang;Wang Chen(Department of Proctology,Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201501,China)

机构地区：[1]上海市金山区中西医结合医院肛肠科,上海201501

出　　处：《结直肠肛门外科》2021年第3期244-248,共5页Journal of Colorectal & Anal Surgery

基　　金：金山区卫健系统第六周期医学重点专科(JSZK2019A02)。

摘　　要：目的观察痔动脉结扎+悬吊缝合+缚扎固定+皮桥整形术治疗环状脱垂性混合痔的临床疗效。方法纳入2018年10月至2019年10月本院收治的78例环状脱垂性混合痔患者作为研究对象,随机将患者分为观察组和对照组,观察组纳入40例,对照组纳入38例。观察组采用痔动脉结扎+悬吊缝合+缚扎固定+皮桥整形术,对照组采用传统外剥内扎术。比较两组临床疗效、术中指标、术后并发症、术后恢复及复发情况。结果两组总显效率、手术时间比较差异均无统计学意义(均P>0.05),观察组术中出血量少于对照组(P<0.05)。术后8 h及术后第1、3、7天,观察组肛门疼痛程度轻于对照组(均P<0.05);观察组术后第3天发热情况优于对照组(P<0.05)。术后第1、3、7、14天,观察组便血程度轻于对照组(均P<0.05);观察组术后第1、3、7天肛缘水肿程度轻于对照组(均P<0.05)。观察组术后8 h尿潴留情况优于对照组(P<0.05)。观察组住院时间、创面愈合时间均短于对照组(均P<0.05)。两组术后28 d均未见肛门失禁病例,肛门狭窄、肛门坠胀、切口感染发生率及术后1年复发率比较差异均无统计学意义(均P>0.05)。结论采用痔动脉结扎+悬吊缝合+缚扎固定+皮桥整形术治疗环状脱垂性混合痔可取得与传统外剥内扎术相近的临床疗效,前者有助于减少术中出血量、减轻术后并发症及缩短创面愈合时间。Objectives To investigate the efficacy of combining hemorrhoidal artery ligation,suspension suture,binding fixation,and skin bridge anoplasty for circumferential prolapsing mixed hemorrhoids.Methods Seventy-eight patients with circumferential prolapsing mixed hemorrhoids treated in our hospital between October 2018 and October 2019 were recruited and randomly assigned to the treatment group(n=40)and the control group(n=38).Patients in the treatment group received a combination of hemorrhoidal artery ligation,suspension suture,binding fixation,and skin bridge anoplasty.Patients in the control group received Milligan-Morgan hemorrhoidectomy.Efficacy,surgical parameters,postoperative complications,recovery,and recurrence were compared between the two groups.Results The two groups did not differ significantly in overall efficacy rate and duration of surgery(P>0.05).Compared to the control group,the treatment group had(1)significantly less intraoperative blood loss;(2)significantly less anal pain at 8 h,1 day,3 days,and 7 days after surgery;(3)significantly less severe fever at 3 days after surgery;(4)significantly less severe hematochezia at 1,3,7,and 14 days after surgery;(5)significantly less severe anal edema at 1,3,and 7 days after surgery;(6)significantly less severe urinary retention at 8 h after surgery;and(7)significantly shorter duration of hospitalization and wound healing time(P<0.05).No patients experienced anal incontinence within 28 days after surgery.Incidence of anal stricture,anal distension,wound infection,and one-year recurrence rate were similar between the two groups(P>0.05).Conclusion Combining hemorrhoidal artery ligation,suspension suture,binding fixation,and skin bridge anoplasty shows comparable efficacy to Milligan-Morgan hemorrhoidectomy for circumferential prolapsing mixed hemorrhoids.The former could help reduce intraoperative blood loss,alleviate postoperative complications,and shorten the time to wound healing.

关 键 词：环状脱垂性混合痔 痔动脉结扎 悬吊缝合 缚扎固定 皮桥整形 

分 类 号：R657.18[医药卫生—外科学]