痔体分割线性结扎术联合RPH治疗脱垂型混合痔的临床疗效分析  

Clinical study on the treatment of prolapsed mixed hemorrhoids by divided linear ligation of hemorrhoids combined with RPH

作　　者：张小兵 熊进文 董坤 黄海球 张雅 ZHANG Xiao-bing;XIONG Jin-wen;DONG Kun(The Second Affiliated Hospital of the Chinese University of Hong Kong(Shenzhen)&Shenzhen Longgang District People's Hospital,Shenzhen 518172,China)

机构地区：[1]香港中文大学(深圳)附属二院&深圳市龙岗区人民医院,518172

出　　处：《中国实用医药》2025年第6期11-15,共5页China Practical Medicine

基　　金：深圳市龙岗区医疗卫生科技计划项目(项目编号:LGWJ2022-37)。

摘　　要：目的 探讨痔体分割线性结扎术联合自动痔疮套扎术(RPH)治疗脱垂型混合痔的临床疗效。方法 选择100例Ⅲ~Ⅳ度脱垂型混合痔患者,随机分为治疗组和对照组,各50例。治疗组采用痔体分割线性结扎术联合RPH术治疗,对照组采用传统外剥内扎术(M-M术)联合RPH治疗。比较两组患者术后视觉模拟评分法(VAS)评分,术后肛门出血评分,临床指标,疗效;分析两组术后情况。结果 两组术后第14天(D14)时VAS评分比较无统计学差异(P>0.05);而治疗组术后第3天(D3)、术后第7天(D7)时VAS评分分别为(2.79±1.01)、(2.26±0.59)分,均低于对照组的(4.30±1.62)、(3.15±1.03)分,差异有统计学意义(P<0.05)。D3、D7和D14时,治疗组患者的肛门出血评分分别为(2.79±0.85)、(2.87±0.58)、(1.95±0.37)分,均低于对照组的(3.30±1.17)、(3.12±0.45)、(2.21±0.48)分,差异有统计学意义(P<0.05)。治疗组患者的住院时间(4.15±1.30)d短于对照组的(4.97±1.61)d,肛缘皮桥水肿评分(2.58±0.21)分低于对照组的(3.07±0.28)分,差异有统计学意义(P<0.05);两组手术时间、术中出血量评分比较无统计学差异(P>0.05)。两组临床总有效率均为100.00%,比较无统计学差异(P>0.05)。术后两组均无大量出血(>800 ml)和肛周严重感染发生,术后均无肛门狭窄需要手术病例,术后均随访6个月均无复发再手术病例。结论 痔体分割线性结扎术联合RPH治疗脱垂型混合痔能有效减少术后肛门出血、缓解疼痛,有效改善患者术后皮桥水肿、缩短住院时间,但长期效果有待评估。Objective To explore the clinical efficacy of divided linear ligation of hemorrhoids combined with ruiyun procedure for hemorrhoids(RPH) in the treatment of prolapsed mixed hemorrhoids.Methods A total of 100 patients with grade Ⅲ-Ⅳ prolapsed mixed hemorrhoids were randomly divided into treatment group and control group,with 50 cases in each group.The treatment group was treated by divided linear ligation of hemorrhoids combined with RPH,while the control group was treated by conventional Milligan-Morgan(M-M) surgery combined with RPH.Both groups were compared in terms of visual analogue scale(VAS) score,postoperative anal bleeding score,clinical indexes and efficacy;the postoperative conditions of the two groups were analyzed.Results There was no statistically significant difference in VAS scores between the two groups on the 14th day after surgery(D14)(P>0.05).On the 3rd day after surgery(D3) and the 7th day after surgery(D7),VAS scores of the treatment group were(2.79±1.01) and(2.26±0.59) points,which were lower than(4.30±1.62) and(3.15±1.03) points of the control group,and the difference was statistically significant(P<0.05).On D3,D7,and D14,the anal bleeding scores of the treatment group were(2.79±0.85),(2.87±0.58),and(1.95±0.37) points,which were lower than(3.30±1.17),(3.12±0.45),and(2.21±0.48) points of the control group,and the difference was statistically significant(P<0.05).The hospitalization time of(4.15±1.30) d in the treatment group was significantly shorter than(4.97±1.61) d in the control group;the anal margin edema score of(2.58±0.21) points in the treatment group was lower than(3.07±0.28) points in the control group;and the differences were statistically significant(P<0.05).There was no statistically significant difference in the operation time and intraoperative bleeding score between the two groups(P>0.05).The overall clinical efficacy rate in both groups was 100.00%,and there was no statistical difference(P>0.05).There were no cases of massive bleeding(>800 ml) or serious per

关 键 词：自动痔疮套扎术 痔体分割线性结扎术 脱垂型混合痔 外剥内扎术 

分 类 号：R657.1[医药卫生—外科学]