内痔原位结扎与脱垂位结扎在混合痔外剥内扎术中的应用效果比较  

Comparison of the clinical effect of in situ ligation of internal hemorrhoids and ligation of prolapse in the Milligan-Morgan operative treatment

作　　者：陈礼平 王丽 CHEN Liping;WANG Li(Proctology Department of Traditional Chinese Medicine,Liuzhou People's Hospital Affiliated to Guangxi Medical University,Guangxi Zhuang Autonomous Region,Liuzhou 545000,China)

机构地区：[1]广西医科大学附属柳州市人民医院中医肛肠科,广西柳州545000

出　　处：《中国当代医药》2024年第9期40-44,共5页China Modern Medicine

基　　金：广西壮族自治区中医药管理局课题(GZZC2019223)。

摘　　要：目的 探讨内痔原位结扎与脱垂位结扎两种不同操作方法在混合痔外剥内扎术(M-M术)中应用的临床效果差异。方法 选取2021年6月至2022年5月广西医科大学附属柳州市人民医院中医肛肠科收住院手术治疗的含有Ⅲ~Ⅳ期内痔的80例混合痔患者作为研究对象,按随机数字表法分成观察组、对照组,每组各40例。两组患者均行M-M术治疗,在结扎内痔时,观察组则采取原位结扎,对照组采用脱垂位结扎。比较两组患者术后切口疼痛、切口水肿、皮赘残留、疗效、尿潴留、大出血及肛门狭窄情况。结果 重复测量方差分析结果显示,两组患者术后第1次排便、术后1、7、14 d疼痛视觉模拟评分法(VAS)评分时间、组间、交互作用比较,差异有统计学意义(P<0.05);观察组患者术后第1次排便、术后1、7、14 d疼痛VAS评分均低于对照组,差异有统计学意义(P<0.05);两组患者术后1 d疼痛VAS评分低于术后第1次排便,术后14 d疼痛VAS评分低于术后7 d,对照组患者术后7 d疼痛VAS评分低于术后1 d,差异有统计学意义(P<0.05);观察组患者术后1 d与术后7 d的疼痛VAS评分比较,差异无统计学意义(P>0.05)。观察组术后切口水肿及皮赘残留程度均低于对照组,差异有统计学意义(P<0.05)。观察组患者的疗效优于对照组,差异有统计学意义(P<0.05)。两组患者均未发生术后大出血及肛门狭窄;两组患者的尿潴留发生率比较,差异无统计学意义(P>0.05)。结论 M-M术中原位结扎内痔较脱垂位结扎内痔,术后切口水肿及疼痛更轻,皮赘残留更少,疗效更佳,具有进一步临床研究应用价值。Objective To investigate the clinical effects of two different methods of in situ ligation of internal hemorrhoids and ligation of prolapse in Milligan-Morgan operative treatment(M-M).Methods A total of 80 patients with mixed hemor-rhoids containing stage II to IV internal hemorrhoids admitted for surgical treatment by the Proctology Department of Tradi-tional Chinese Medicine,Liuzhou People's Hospital Affiliated to Guangxi Medical University from June 2021 to May 2022 were included and divided into the observation group and the control group according to random number table method,with 40 patients in each group.M-M operation was performed in both groups.When ligation internal hemorrhoids,the observa-tion group was ligation in situ,while the control group was ligation in prolapsed position.Incision pain,incision edema,residual skin mark,curative effect,urinary retention,massive hemorrhage and anal stenosis were compared between the two groups.Results Repeated measurement ANOVA results showed that there were statistically significant diferences in the first postoperative defecation,pain visual analogue scale score time,inter-group and interaction between the two groups(P<0.05).The pain VAS scores at the first postoperative defecation,1,7 and 14 days after surgery in observation group were lower than those in control group,with statistical significance(P<0.05).Pain VAS score 1 day after surgery was lower than the first postoperative defecation in two groups,pain VAS score 14 days after surgery was lower than 7 days after surgery,and pain VAS score 7 days after surgery in control group was lower than 1 day after surgery,the differences were statistically significant(P<0.05).There was no significant difference in the pain VAS score between the observation group and the observation group between day 1 and day 7 after surgery(P>0.05).The degree of postoperative incision ede-ma and skin tags in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The

关 键 词：混合痔 外剥内扎术 内痔原位结扎术 切口水肿 皮赘残留 

分 类 号：R657.18[医药卫生—外科学]