PPH双荷包缝合法与RPH串联套扎法在老年Ⅲ~Ⅳ度脱垂性痔病患者中的应用效果对比  

Comparison of the effect of PPH double purse-string suture and RPH series ligation in elderly patients with Ⅲ-Ⅳ degree prolapsed hemorrhoids

作　　者：李乾国 张正勇 代剑波 余庆三 廖落星 管祥立 陈浩桢 Li Qianguo;Zhang Zhengyong;Dai Jianbo;Yu Qingsan;Liao Luoxing;Guan Xiangli;Chen Haozhen(Department of General Surgery,Nan’an District People’s Hospital of Chongqing,Chongqing 400060,China)

机构地区：[1]重庆市南岸区人民医院普通外科,重庆400060

出　　处：《结直肠肛门外科》2023年第1期67-72,共6页Journal of Colorectal & Anal Surgery

摘　　要：目的 对比分析吻合器痔上黏膜环切钉合术(PPH)双荷包缝合法与自动弹力线痔套扎术(RPH)串联套扎法在老年Ⅲ~Ⅳ度脱垂性痔病患者中的应用效果。方法 纳入重庆市南岸区人民医院2020年12月至2021年11月收治的136例老年Ⅲ~Ⅳ度脱垂性痔病患者为研究对象,按照随机数字表法分为两组,即改良PPH组(n=68,采用PPH双荷包缝合法)与改良RPH组(n=68,采用RPH串联套扎法)。观察比较两组手术相关指标(手术时间、术中出血量与术中内脏神经反射发生率),术后(首次排粪时、第1天非排粪时、第7天非排粪时)肛门疼痛程度,术后恢复相关指标(伤口愈合时间、住院时间、首次恢复工作所需时间),临床疗效,并发症发生情况,复发情况,以及住院费用和满意度。结果 改良RPH组的手术时间、首次恢复工作所需时间均短于改良PPH组,伤口愈合早于改良PPH组,术中出血量少于改良PPH组,术中内脏神经反射发生率、术后并发症的总发生率低于改良PPH组(均P<0.05);两组住院时间、住院费用比较差异均无统计学意义(均P>0.05)。改良RPH组术后首次排粪时、术后第1天非排粪时的肛门疼痛VAS评分均低于改良PPH组(均P<0.05);两组术后第7天非排粪时的肛门疼痛VAS评分比较差异无统计学意义(P>0.05)。改良PPH组的临床疗效显著率、满意率、复发率、总体临床疗效、总体满意度均优于改良RPH组(均P<0.05)。结论 PPH双荷包缝合法、RPH串联套扎法均可用于治疗老年Ⅲ~Ⅳ度脱垂性痔病患者,临床疗效和患者满意度均较为理想。其中PPH双荷包缝合法在总体临床疗效、患者满意度、减少复发方面更有优势,RPH串联套扎法在缩短手术时间、首次恢复工作所需时间、伤口愈合时间,减少术中出血量、术中内脏神经反射、术后并发症,减轻术后肛门疼痛方面更有优势。Objectives To compare and analyze the effect of procedure for prolapse and hemorrhoids(PPH) double purse-string suture and Ruiyun procedure for hemorrhoids(RPH) series ligation in elderly patients with Ⅲ-Ⅳ degree prolapsed hemorrhoids.Methods One hundred thirty-six elderly patients with Ⅲ-Ⅳ degree prolapsed hemorrhoids treated in Nan’an District People’s Hospital of Chongqing from December 2020 to November 2021 were included in the current study. Patients were divided into modified PPH group(n=68, using PPH double purse-string suture method) and modified RPH group(n=68, using RPH series ligation method) according to the random number table. Operation-related indicators(operation time, intraoperative hemorrhage, and intraoperative visceral nerve reflex incidence), postoperative(first defecation, non-defecation on the first day, non-defecation on the seventh day) anus pain, postoperative recovery-related indicators(wound healing time, hospitalization time, time required for first recovery of work), clinical efficacy, complications, and recurrence, as well as hospitalization costs and satisfaction were compared. Results The operation time and the time required for the first recovery of work of the modified RPH group were shorter than the modified PPH group, the wound healing time was earlier than the modified PPH group, the intraoperative hemorrhage was less than the modified PPH group, the intraoperative visceral nerve reflex rate and the total postoperative complications rate were lower than those of the modified PPH group(P<0.05). The hospitalization time and hospitalization costs between the two groups was not statistically significant(P>0.05). The visual analogue scales(VAS) scores of anus pain in the modified RPH group were lower than that in the modified PPH group at the first defecation and the non-defecation on the first day after the operation(P<0.05). The difference was not statistically significant in VAS score of anus pain during non-defecation on the seventh day after operation between the

关 键 词：脱垂性痔病 吻合器痔上黏膜环切钉合术双荷包缝合法 自动弹力线痔套扎术串联套扎法 老年患者 临床疗效 

分 类 号：R657.18[医药卫生—外科学]