选择性痔上黏膜切除术与吻合器痔上黏膜环切钉合术治疗重度内痔的临床疗效对比

目的分析对比选择性痔上黏膜切除术（TST）与吻合器痔上黏膜环切钉合术（PPH）治疗重度内痔的临床疗效及并发症发生率。方法回顾性分析福建医科大学附属第一医院胃肠外科于2010年11月至2012年1月收治的542例重度内痔患者的临床资料。其中TST治疗组258例，PPH治疗组284例，评估两组患者手术情况和术后3个月疗效及并发症发生率。结果TST组手术时间（20．6±4．7）min]和术后住院时间（2．9±0．5）d]明显短于PPH组（26．4±6．3）min和（3．5±0．7）d]（均P〈0．05）。TST组和PPH组治愈率分别为96．5％（249／258）和95．4％（271／284），差异无统计学意义（P〉O．05）；但TST组患者术后疼痛、出血量、肛门坠胀感及尿潴留的评分值均明显低于PPH组（P〈0．01）。术后TST组无肛门狭窄发生，而PPH组有5例（1．8％）出现肛门狭窄（P〈0．01）。结论TST与PPH治疗重度内痔临床疗效均满意．但行TST的患者术后恢复快，并发症发生率低。

Efficacy comparison of tissue selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of severe hemorrhoids

Objective To compare the efficacy and complication of tissue selecting therapy stapler （TST） and procedure for prolapse and hemorrhoids （PPH） in the treatment of severe hemorrhoids. Methods Clinical data of 542 cases of severe hemorrhoids undergoing TST（258 cases） or PPH （284 cases） in The First Affiliated Hospital of Fujian Medical University from November 2010 to January 2012 were analyzed retrospectively. Operaitve parameters, efficacy and complication 3 months after operation were assessed and compared. Results No significant difference in cure rate between TST and PPH（96.5% vs. 95.4%） was found, while the operation time and hospital stay after operation in TST group were significantly shorter urgency （20.6±4.7） vs. （26.4±6.3） min, （2.9±0.5） vs. （3.5±0.7） d, both P〈0.05]. Incidences of postoperative pain, bleeding, anal urgency and urinary retention in TST group were significantly lower than those in PPH group （all P〈0.01）. No anal stenosis was observed in TST group, and 5 cases developed anal stenosis in PPH group （P〈0.05）. Hemorrhoid recurrence did not differ significantly between the two groups. Conclusions The efficacy of TST and PPH is comparable for severe hemorrhoids patients, while TST is associated with faster postoperative recovery and less complications.