外剥内扎术结合残余痔组织剥除、痔上黏膜套扎术治疗环状混合痔137例疗效分析  

Analysis of the effect of M-M procedure,excision of residual piles tissue and above mucosa ligation on 137 cases of circumferential mixed hemorrhoids

作　　者：王俊[1] 马良欢 金黑鹰[1] WANG Jun;MA Lianghuan;JIN Heiying(Department of Colorectal Surgery,Second Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210017,China;Anorectal of Haiyan County Hospital of Traditional Chinese Medicine,Jiaxing,Zhejiang 314300,China)

机构地区：[1]南京中医药大学第二附属医院肛肠中心,江苏南京210017 [2]海盐县中医院肛肠科,浙江嘉兴314300

出　　处：《安徽医药》2024年第10期1952-1956,I0004,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的观察外剥内扎术结合残余痔组织剥除、痔上黏膜套扎术(M-M procedure,excision of residual piles tissue and above mucosa ligation,MEAL)治疗环状混合痔的临床疗效。方法收集2019年1月至2020年1月于南京中医药大学第二附属医院肛肠中心接受MEAL的54例环状混合痔病人作为实验组(MEAL组);以同期47例行单纯外剥内扎术(M-M组)和36例行选择性痔上黏膜切除术(TST组)的病人为对照组,分别比较各组病人的住院时间、创面愈合时间、皮赘残留、痔疮复发、肛门狭窄及肛门失禁情况。结果随访时间为(351.80±110.28)d,MEAL组的住院时间和对照组比较,差异无统计学意义(均P>0.05);MEAL组的创面愈合时间(11.55±1.67)d短于M-M组(12.38±1.91)d及TST组(12.38±2.11)d,均差异有统计学意义(均P<0.05);MEAL组的痔疮复发率1.85%(1/54)、皮赘残留发生率18.52%(10/54)均低于M-M组痔疮复发率14.89%(7/47)、皮赘残留发生率36.17%(17/47)及TST组痔疮复发率16.66%(6/36)、皮赘残留发生率41.67%(15/36),差异有统计学意义(均P<0.05);全组均无肛门失禁及肛门狭窄病例。结论基于M-M的MEAL治疗环状混合痔具有减少创面、降低复发率等优点,在保护肛门的同时,明显减少了皮赘残留的发生。Objectives To observe the clinical efficacy of MEAL(M-M procedure,Excision of residual piles tissue and Above mucosa Ligation)in the treatment of circumferential mixed hemorrhoids.Methods The clinical data of 54 patients with circumferential mixed hemorrhoids who underwent MEAL in the anorectal center of the Second Affiliated Hospital of Nanjing University of traditional Chinese medicine from January 2019 to January 2020 were collected as the experimental group(MEAL group).In the same period,47 patients underwent Milligan-Morgan hemorrhoidectomy(M-M group)and 36 patients underwent Tissue-selecting Therapystapler(TST group)were selected as the control group.The hospitalization time,wound healing time,residual skin tumor,hemorrhoids recurrence,anal stricture and anal incontinence of MEAL group,M-M group and TST group were compared.Results There was no significant difference in length of stay between MEAL group and control group(P>0.05).The wound healing time of MEAL group(11.55±1.67)days was shorter than that of M-M group control group(12.38±1.91)days and TST group(12.38±2.11)days,and the differences were statistically significant(both P<0.05).The recurrence rate of hemorrhoids in the MEAL group was 1.85%(1/54),and the incidence of residual skin tags was 18.52%(10/54),both lower than the recurrence rate of hemorrhoids[14.89%(7/47)]and the incidence of residual skin tags[36.17%(17/47)]in the M-M group,and the recurrence rate of hemorrhoids[16.66%(6/36)]and the incidence of residual skin tags[41.67%(15/36)]in the TST group,with statistical significance(all P<0.05).There were no cases of anal incontinence or anal stenosis.Conclusions MEAL in the treatment of circumferential mixed hemorrhoids has the advantages of reducing the wound and the recurrence rate.It can protect the anus and significantly reduce the occurrence of residual skin.

关 键 词：混合痔 痔切除术 外剥内扎术结合残余痔组织剥除、痔上黏膜套扎术 选择性痔上黏膜切除术 临床研究 

分 类 号：R657.18[医药卫生—外科学]