自动弹力线痔套扎术治疗老年混合痔的临床效果观察  

Effect of automatic elastic thread hemorrhoid ligation for treating older patients with mixed hemorrhoids

作　　者：李龙[1] 朱仲军 李良[1] Li Long;Zhu Zhongjun;Li Liang(Department of General Surgery,Hefei Second People’s Hospital,Hefei 231000,Anhui,China)

机构地区：[1]合肥市第二人民医院普外科,安徽合肥231000

出　　处：《结直肠肛门外科》2021年第3期258-261,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨自动弹力线痔套扎术治疗老年混合痔患者的临床效果。方法选取2018年5月至2019年9月本院收治的92例老年混合痔患者作为研究对象,采用随机数字表法将入组患者分为观察组(n=46,采用自动弹力线痔套扎术)和对照组(n=46,采用传统外剥内扎术)。比较两组术中出血量、手术时间、住院时间、疗效、术后第1天、第4天和第7天的创面疼痛程度、应激指标(ACTH、COR)水平、肛门功能(ARP、AMCP、Wexner评分)。结果观察组手术时间、住院时间短于对照组,术中出血量少于对照组,差异均有统计学意义(均P<0.05)。观察组总有效率为93.5%,对照组为87.0%,两组总有效率比较差异无统计学意义(P>0.05)。两组术后第4天、第7天的创面疼痛VAS评分均低于术后第1天,且观察组术后不同时点的创面疼痛VAS评分均低于对照组,差异有统计学意义(均P<0.05)。术后,两组ACTH和COR水平均高于术前,ARP、AMCP和肛门失禁Wexner评分均低于术前,且观察组ACTH、COR水平和肛门失禁Wexner评分均低于对照组,ARP、AMCP均高于对照组,差异有统计学意义(均P<0.05)。结论自动弹力线痔套扎术与传统外剥内扎术治疗老年混合痔患者的临床疗效相当,但前者可较好保护患者肛门功能,且术后疼痛感和应激反应较轻、肛门功能恢复更快。Objectives To investigate the clinical effect of automatic elastic thread hemorrhoid ligation for treating older patients with mixed hemorrhoids.Methods Ninety-two older patients with mixed hemorrhoids treated at our hospital between May 2018 and September 2019 were recruited.Patients were randomly assigned to treatment group(n=46,receiving automatic elastic thread hemorrhoid ligation)and control group(n=46,receiving Milligan-Morgan hemorrhoidectomy).The followings were compared between the two groups:intraoperative blood loss,duration of surgery,length of hospital stay,effectiveness(cured,effective,and ineffective),wound pain evaluated using the visual analog scale(VAS)at 1 day,4 day,and 7 days after surgery,stress response(adrenocorticotropic hormone[ACTH]and cortisol[COR]),and anal function(anal resting pressure[ARP],anal maximal contraction pressure[AMCP],and Wexner score).Results Compared with the control group,duration of surgery and length of hospital stay were significantly shorter,and intraoperative blood loss was significantly less in the treatment group(P<0.05).The overall effectiveness rate(cured or effective)was 93.5%in the treatment group and 87.0%in the control group with no significant differences between the two groups(P>0.05).The wound pain VAS at 4 and 7 days after surgery decreased significantly from that at 1 day after surgery in both groups,and patients in the treatment group had significantly less wound pain at all time points(P<0.05).In both groups,levels of ACTH and COR increased,and ARP,AMCP,and Wexner score decreased after surgery.Compared with the control group,the treatment had significantly lower levels of ACTH and COR,significantly lower Wexner score,and significantly higher ARP and AMCP(P<0.05).Conclusion Automatic elastic thread hemorrhoid ligation yields comparable clinical effect to traditional Milligan-Morgan hemorrhoidectomy for treating older patients with mixed hemorrhoids.The former can better protect patients’anal function and is associated with fewer postoperative wound

关 键 词：混合痔 老年患者 自动弹力线痔套扎术 疼痛 应激 肛门功能 

分 类 号：R657.18[医药卫生—外科学]