环状混合痔的术式设计探讨

目的观察采用不同剥扎术式治疗环状混合痔的疗效,并探讨肛门括约肌功能与环状混合痔发病的关系。方法对环状混合痔采用分段外痔剥离、内痔结扎,与消痔灵液注射非结扎区内痔的方法治疗;其中静脉曲张环状混合痔不松解肛门括约肌,结缔组织型环状混合痔给予肛门括约肌松解。结果165例总有效率100%,其中治愈158例占96.34%,显效6例占3.66%;疗程12~21 d,平均16 d;手术后1 a随访156例,其中2例偶有肛门潮湿和瘙痒,无一例复发或继发肛裂、肛门狭窄。结论结缔组织型环状混合痔患者其肛门括约肌紧张,弹性差,手术中给予肛门括约肌松解既可减轻手术后疼痛,防止局部水肿,又能防止手术后肛门狭窄。静脉曲张型环状混合痔患者其肛门括约肌大多松弛,手术中不松解肛门括约肌,也不会引起肛门狭窄。

Discussion on the operation design of circumferential mixed hemorrhoids

Objective It is to observe the effect of different ligations for circumferential mixed hemorrhoids,and approach the relationship between the function of the Anal Sphincter and the morbidity of circumferential mixed hemorrhoids.Methods The method of external dissection and internal ligation was used for circumferential mixed hemorrhoids,and inject the un-ligated area with Xiaozhiling.The method of relax the anal sphincter was done for phoroplast type of circumferential mixed hemorrhoids but not for the cirsoid types.Results The total effective rate was 100%(164/164),158 cases were cured(96.34%),6 cases had marked effect(3.66%).The course of treatment was 12 to 21 days and the average duration was 16 days.At follow up after a year of the procedure in 156 patients,except for anal moistness and pruritus seldom in 2 patients,no recurrence,anal fissure or stricture of anus was occurred.Conclusion For the patient with phoroplast type of circumferential mixed hemorrhoids,relaxation of the anal sphincter in the surgery can relieve postoperative pain,prevent local edema or postoperative stricture of anus because the muscle is contracted and the elasticity is not good.But for the patient with cirsoid types the relaxation is not necessary because the anal sphincter is relaxed and the structure of anus will not happen.