改良单荷包四点牵引PPH在环状混合痔中的应用

目的比较改良单荷包四点牵引法与传统单荷包单点牵引法吻合器痔上黏膜环切术（PPH）治疗环状混合痔中的临床疗效。 方法选取2017年1月至2019年1月联勤保障部队第九〇〇医院普通外科收治的140例环状混合痔患者的临床资料，随机分成改良组和传统组，各70例，改良组采用单荷包四点牵引PPH，传统组采用单荷包单点牵引PPH。对两组临床疗效、术中情况、术后并发症及复发情况进行比较。 结果改良组与传统组治愈率分别为95.71%和82.86%，差异有统计学意义（χ²=6.048，P=0.014）。改良组切除的黏膜环的宽度（t=12.772，P<0.05）、黏膜环均匀程度（χ²=7.368，P<0.05）、痔核完全回缩（χ²=6.048，P<0.05）均优于传统组，差异有统计学意义；术后随访1年，改良组和传统组复发率分别为0.00%和7.14%，差异有统计学意义（χ²=5.185，P<0.05）；两组手术时间（t=1.081，P>0.05）和术中出血（χ²=0.085，P>0.05）差异无统计学意义；术后第1天、第7天的VAS疼痛评分差异无统计学意义（t_1d=0.731，t_7d=1.243；P>0.05）；改良组与传统组术后并发症总体发生率分别为8.57%和20%，差异无统计学意义（χ²=3.773，P>0.05）；两组住院时间差异无统计学意义（t=0.335，P>0.05）。 结论改良的单荷包四点牵引法PPH与传统单荷包单点牵引法PPH相比，术中切除的黏膜环较均匀一致，痔核回缩效果好，治愈率高，复发率低，值得临床应用。

The application of modified single loaded four point traction PPH in circular mixed hemorrhoids

ObjectiveTo compare the clinical efficacy of modified single loaded four point traction with traditional single packed single point traction PPH for the treatment of circular mixed hemorrhoids. MethodsFrom January 2017 to January 2019, 140 patients with circular mixed hemorrhoids were randomly divided into modified group and traditional group, seventy patients each, the modified group was single loaded four point traction PPH, the traditional group was single loaded single point traction PPH. The clinical efficacy, intraoperative conditions, postoperative complications and recurrence of the two groups were compared. ResultsThe cure rates of the modified group and the traditional group were 95.71% and 82.86% respectively, the difference was statistically significant (χ²=6.048, P=0.014). The width (t=12.771), uniform mucosal ring (χ²=7.368) and complete retraction of hemorrhoid nucleus (χ²=6.048) in the modified group were better than those in the traditional group (P<0.05). After one year follow-up, the recurrence rate of the modified group and the traditional group was 0.00% and 7.14% respectively, the difference was statistically significant (χ²=5.185, P<0.05); Two groups had no significant difference in operative time (t=1.081) and intraoperative bleeding (χ²=0.085) (P>0.05). There was no significant difference in VAS pain scores on one day and seven days (t_1d=0.731, t_7d=1.243; P>0.05). The total incidence of postoperative complications was 8.57% and 20% in the modified group and the traditional group (χ²=3.773, P>0.05).There was no significant difference in hospitalization time between the two groups (t = 0.335, P>0.05). ConclusionCompared with the traditional single loaded single point traction PPH, the modified single laoded four point traction method is more uniform, the hemorrhoid nucleus retracts well, the cure rate is high, and the recurrence rate is low, which is worthy of clinical application.