RPH-4套扎外痔切除术对重度痔病患者机体创伤程度及疼痛介质的影响  

Effect of RPH-4 Ligation and External Hemorrhoidectomy on Degree of Trauma and Pain Mediators in Patients with Severe Hemorrhoids

作　　者：邹纬 张建华 武飚[1] ZOU Wei;ZHANG Jianhua;WU Biao(The Second Department of General Surgery,Taiyuan Central Hospital,Taiyuan 030009,China)

机构地区：[1]太原市中心医院普外二科,太原030009

出　　处：《临床误诊误治》2023年第4期73-77,共5页Clinical Misdiagnosis & Mistherapy

基　　金：山西省卫生健康委科研基金项目(210518SX056)。

摘　　要：目的探讨自动弹力线痔疮套扎器(RPH-4)套扎外痔切除术治疗重度痔病的效果及对机体创伤程度、疼痛介质的影响。方法选取2020年2月—2022年2月收治的重度痔病90例,依据治疗术式不同分为A组46例、B组44例。A组行RPH-4套扎外痔切除术,B组行外剥内扎术。比较2组手术相关指标、并发症、术后疼痛程度,以及手术前后炎性因子、疼痛介质、肛肠动力学指标。结果A组术中出血量较B组少,手术时间、住院时间及创面愈合时间较B组短,术后1、3、5、7 d的视觉模拟评分法评分较B组低(P<0.01)。术后3、7 d,2组血清白细胞介素-6、C反应蛋白、肿瘤坏死因子-α、前列腺素E_(2)、神经肽Y、P物质水平均较术前高,但A组均较B组低(P<0.05)。术后1个月,A组直肠最大耐受容量、肛管最大收缩压均较B组高,直肠静息压、直肠肛管抑制反射阈值均较B组低(P<0.05)。A组术后并发症总发生率较B组低(P<0.05)。结论应用RPH-4套扎外痔切除术治疗重度痔病可减轻手术创伤与术后疼痛感,减少炎性因子、疼痛介质分泌与并发症发生,且对肛肠功能影响小。Objective To investigate the effect of automatic elastic thread hemorrhoid ligation device(RPH-4)ligation and external hemorrhoidectomy on severe hemorrhoids and its effect on body trauma and pain mediators.Methods Ninety cases of severe hemorrhoids treated from February 2020 to February 2022 were selected and divided into group A(n=46)and group B(n=44)according to different treatment methods.RPH-4 ligation and external hemorrhoidectomy was performed in group A,and external stripping and internal ligation was performed in group B.Operation related indexes,complications,postoperative pain degree,inflammatory factors,pain mediators and anorectal dynamics indexes before and after operation were compared between the two groups.Results The intraoperative blood loss in group A was less than that in group B,and the duration of operation,length of hospital stay and wound healing time were shorter than those in group B;the visual analog score at 1,3,5 and 7 d after surgery was lower than that in group B(P<0.01).At 3 and 7 d after surgery,serum levels of interleukin-6,C-reactive protein,tumor necrosis factor-α,prostaglandin E_(2),neuropeptide Y and P in 2 groups were higher than those before surgery,but lower in group A than in group B(P<0.05).At one month after surgery,the maximum rectal tolerable capacity and maximum rectal systolic pressure in group A were higher than those in group B,while the rectal resting pressure and the threshold of rectal inhibition reflex were lower than those in group B(P<0.05).The total incidence of postoperative complications in group A was lower than that in group B(P<0.05).Conclusion RPH-4 ligation and external hemorrhoidectomy in the treatment of severe hemorrhoids can reduce surgical trauma and postoperative pain,reduce inflammatory factors,pain mediators secretion and complications,and have little effect on anorectal function.

关 键 词：痔 RPH-4套扎外痔切除术 疼痛 白细胞介素-6 C反应蛋白 前列腺素E_(2) P物质 直肠静息压 

分 类 号：R657.18[医药卫生—外科学]