齿线上方黏膜C形切除吻合术治疗Ⅳ度混合痔的疗效及术后复发情况分析  

Analysis of the effect and postoperative recurrence of grade V mixed hemorrhoids treated by C-shaped mucosal resection and anastomosis above the dentate line

作　　者：汪铁钢 端传友[1] 吴国魁 韩建波 童菲 张波[3] 曹红勇[4] WANG Tiegang;DUAN Chuanyou;WU Guokui;HAN Jianbo;TONG Fei;ZHANG Bo;CAO Hongyonga(Department of General Surgery,Nanjing Liuhe District People's Hospital(Liuhe Hospital Affiliated to Yangzhou University Medical College),Nanjing 210000,P.R.China;Department of General Surgery,Nanjing Red Cross Hospital,Nanjing 210001,P.R.China;Department of Proctology,Zhongda Hospital Southeast University,Nanjing 210009,P.R.China;Department of General Surgery,Nanjing Hospital of Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,P.R.China)

机构地区：[1]南京市六合区人民医院(扬州大学医学院附属六合医院)普外科,南京210000 [2]南京市红十字医院普外科,南京210001 [3]东南大学附属中大医院肛肠科,南京210009 [4]南京医科大学附属南京医院(南京市第一医院)普外科,南京210006

出　　处：《中国普外基础与临床杂志》2024年第6期726-732,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨齿线上方黏膜C形切除吻合术治疗Ⅳ度混合痔的疗效及对肛门功能的影响。方法回顾性收集2015年6月至2018年2月期间于南京市六合区人民医院接受治疗的78例Ⅳ度混合痔患者,依据治疗方法将患者分为对照组和观察组,每组39例。对照组接受传统吻合器痔上黏膜环切钉合术(procedurefor prolapse and hemorrhoids,PPH),观察组接受齿线上方黏膜C形切除吻合术。比较2组患者的围手术期指标(手术时间、术中出血量、住院时间等)、主观功能评价指标(Wexner便秘评分、Kirwan分级等)、临床疗效和复发率。利用随机行走模型进行临床疗效评价。结果观察组患者的术中出血量[(27.9±3.4)mL比(43.2±5.2)mL,P<0.001]、24 h视觉模拟评分[(4.2±1.5)分比(5.6±1.5)分,P<0.001]、第1次排便疼痛持续时间[(22.1±3.3)min比(34.2±5.0)min,P<0.001]、带血时间[(4.1±0.4)d比(5.7±0.6)d,P<0.001]和水肿时间[(3.2±0.6)d比(4.7±0.9)d,P<0.001]均短(低)于对照组;观察组患者手术前后Wexner便秘评分差值[(13.2±2.4)分比(11.7±2.1)分,P=0.004]、肛管静息压差值[(23.1±4.9)mmHg比(17.8±3.4)mmHg,P<0.001]和肛管最大缩榨压差值[(33.5±7.3)mmHg比(23.1±5.6)mmHg,P<0.001]均高于对照组。2组患者Wexner便秘评分、Kirwan分级、直肠肛门抑制反射阳性率、肛管静息压和肛管最大缩榨压的随机波动幂率值的变化和患者接受的术式存在长程关联。观察组的总有效率[97.4%(38/39)比66.7%(26/39)]和未复发率[92.3%(36/39)比76.9%(29/39)]均高于对照组(P<0.05),但总并发症发生率和对照组比较差异无统计学意义[5.1%(2/39)比12.8%(5/39),P=0.235]。结论与传统PPH比较,齿线上方黏膜C形切除吻合术治疗Ⅳ度混合痔可提高治疗效果,降低术后复发率,维持肛门功能,有利于患者恢复。Objective To investigate the curative effect of C-shaped mucosal resection and anastomosis above the dentate line in the treatment of mixed hemorrhoids and its effect on anal function.Methods A total of 78 patients with degree IV mixed hemorrhoids treated in Nanjing Liuhe District People's Hospital from June 2015 to February 2018 were retrospectively collected.The patients were divided into control group(n=39)and observation group(n=39)according to treatment methods.Patients of the control group received traditional procedure for prolapse and hemorrhoids operation,while patients of the observation group received C-shaped mucosal resection and anastomosis above the dentate line.The perioperative indexes(operation time,intraoperative blood loss,hospital stay,etc.),subjective function evaluation indexes(Wexner constipation score,Kirwan grade,etc.),clinical efficacy and recurrence rate were compared between the two groups.The random walking model was used to evaluate the clinical curative effect.Results The intraoperative blood loss[(27.9±3.4)mL vs.(43.2±5.2)mL,P<0.001],24 h visual analogue scale score[(4.2±1.5)points vs.(5.6±1.5)points,P<0.001],duration of first defecation pain[(22.1±3.2)min vs.(34.2±5.0)min,P<0.001],the time of carrying blood[(4.10.4)d vs.(5.7±0.6)d,P<0.001],and the time of edema[(3.2±0.6)d vs.(4.7±0.9)d,P<0.001]in the observation group were shorter(lower)than those in the control group.The difference between pre-and post-operation of Wexner constipation score[(13.2±2.4)points vs.(11.7±2.1)points,P=0.004],resting pressure[(23.1±4.9)mmHg vs.(17.8±3.4)mmHg,P<0.001]and maximum squeeze pressure[(33.5±7.3)mmHg vs.(23.1±5.6)mmHg,P<0.001]in the observation group were significantly higher than those in the control group.There was a long-term correlation between changes in random fluctuating power rate values of Wexner constipation score,Kirwan grade,rectoanal inhibitory reflex positive rate,resting pressure,maximum squeeze pressure and the surgical procedure received by the patient of the tw

关 键 词：Ⅳ度混合痔 齿线上方黏膜C形切除吻合术 疗效 肛门功能 

分 类 号：R657.18[医药卫生—外科学]