联合应用吻合器痔上黏膜环切术和痔切闭术治疗重度痔的临床研究

目的 对联合应用吻合器痔上黏膜环切术(PPH)和痔切闭术治疗重度痔的临床效果进行评估.方法 60例重度痔患者(Ⅲ、Ⅳ度,均为行PPH后部分或全部痔不能收入肛管内者),按随机数字表法均分成A、B两组,A组行PPH加痔切闭术,B组行PPH加外剥内扎术.对其术后疗效进行比较研究.结果 A、B组手术时间分别为(35.6±5.3)、(47.3±10.2)min,术后24 h视觉疼痛模拟评分分别为(2.9±1.2)、(5.7±1.9)分,术后伤口愈合时间分别为(6.3±1.4)、(28.5±4.8)d,A组疗效明显优于B组(P＜0.05).随访6个月,两组均无复发病例.结论 联合应用PPH和痔切闭术治疗重度痔是一种简单、安全、可靠的术式,疗效优于PPH加外剥内扎术.

Clinical study on combination of procedure for prolapse and hemorrhoids and excision-closed hemorrhoidectomy for severe hemorrhoids

Objective To demonstrate the feasibility, effectiveness and reliability of combination of procedure for prolapse and hemorrhoids (PPH) and excision-closed hemorrhoidectomy (ECH) for severe hemorrhoids. Methods Sixty patients with Ⅲ- Ⅳ degree hemorrhoids which left remnant prolapsed hemorrhoids after stapled hemorrhoidopexy, were randomly divided into group A (PPH with additional ECH group,30 cases.) and group B PPH with additional Milligan-Morgan hemorrhoidectomy (MMH) group, 30 cases]. Ten indexes of the results in two groups were compared. Results The hemorrhoidectomy lasted (35.6 ± 5.3) min in group A and (47.3 ± 10.2) min in group B. The indexes related to 24 h visual analogue scale (VAS) after operation were (2.9 ± 1.2) scores in group A and (5.7 ± 1.9) scores in group B. Wound healing time were (6.3 ± 1.4) d in group A and (28.5 ± 4.8) d in group B. Many indexes showed the results in group A was better than those in group B ( P ＜ 0.05 ). The six-month follow-up visits after operation showed no complications, such as recurrence in either group. Conclusions Combination treatment for Ⅲ -Ⅳ degree hemorrhoids with PPH with additional ECH is a easy,safe,reliable,minimal-aching and quick-recovering method of hemorrhoidectomy with favorable results than PPH with additional MMH.