PPH联合直视下痔上动脉结扎治疗Ⅲ Ⅳ度混合痔的疗效及安全性  

The efficacy evalution of PPH combinded with direct hemorrhoid artery ligation in treatment of grade Ⅲ and Ⅳ hemorrhoids

作　　者：黎淑玲 刘俊杰 蒋邦好 罗劲根 LI Shuling;LIU Junjie;JIANG Banghao;LUO Jingen(Department of General Surgery,Guangzhou Panyu Central Hospital,Guangzhou 51140Q,China)

机构地区：[1]广州市番禺区中心医院普外科,广东广州511400

出　　处：《安徽医学》2022年第11期1264-1267,共4页Anhui Medical Journal

基　　金：广州市番禺区科技计划项目(项目编号:2020-Z04-018)。

摘　　要：目的观察痔上动脉结扎(HAL)术对中重度混合痔患者的手术效果及对术后并发症的影响。方法选取2019年6月至2020年6月广州市番禺区中心医院收治的148例混合痔合并出血性内痔患者作为研究对象,采用随机数字表法分为对照组与观察组,每组74例。对照组行痔上黏膜环切术(PPH)术,观察组行PPH联合HAL。观察比较两组患者手术时间、住院时间、住院费用,术后急性尿潴留,术后3个月内出血、脱垂、水肿、肛门狭窄、视觉疼痛模拟评分(VAS)、Wexner肛门失禁评分、疗效等指标的差异。结果观察组手术时间较对照组更长,住院时间较对照组更短,住院费用较对照组更低,差异有统计学意义(P<0.05)。观察组术后出血比例为5.41%、水肿发生率为9.46%、Wexner肛门失禁评分为(2.32±1.25)分,均低于对照组,差异有统计学意义(P<0.05);观察组有效率为94.59%,高于对照组,差异有统计学意义(P<0.05)。手术后,两组VAS评分均降低,术后观察组VAS低于对照组,差异有统计学意义(P<0.05)。观察组术后急性尿潴留、脱垂、肛门狭窄发生情况与对照组比较,差异无统计学意义(P>0.05)。结论PPH联合直视下HAL治疗出血性中重度混合痔安全有效,并发症发生率更低,具有临床应用价值。Objective To explore the clinical efficacy and postoperative complications of the procedure for prolapse and hemorrhoids(PPH) combined with direct hemorrhoid artery ligation(HAL) as a therapy for patients with moderate or severe hemorrhoids. Methods A total of 148 patients complained of hemorrhoids and bleeding symptoms from Jun 2019 to Jun 2020 were randomly divided into control group(n=74) and observation group(n=74). Operation time consuming, hospitalization time, expense, acute urinary retention, post operative bleeding, prolapse, swelling, anal stenosis, visual analogue scal(VAS), Wexner incontinence grading scale, satisfaction and efficacy within 3 months post operation were observed and analyzed. Results Compared with the control group, the observation group costed more operation time, less hospitalization time and expense(P<0.05). The postoperative bleeding rate of the observation group was 5.41%,the swelling occurence rate was 9.46% and the incontinence score was(2.32±1.25), which were lower than that of the control group(P<0.05).The effectiveness of the observation group was 94.59%,which was higher than the control group(P<0.05). The VAS decreased postoperatively in both group and the pain relieved more significantly among the observation group(P<0.05).The incidence rate of urinary retention, swelling and anal stenosis was of no significant differences(P>0.05). Conclusions PPH combined with direct HAL applying to the patients with moderate or severe hemorrhagic hemorrhoids is safe and effective. Such operation is of low incidence of postoperative complications and is worth of widely clinical application.

关 键 词：混合痔 吻合器痔上黏膜环切术 痔动脉结扎 术后并发症 

分 类 号：R657.18[医药卫生—外科学]