不同术式治疗环状混合痔的临床疗效观察及其成本效果分析

目的：对比研究不同术式吻合器痔上粘膜环切术（PPH）与外剥内扎术（M-M）治疗环状混合痔的的临床疗效及安全性，并评价其卫生经济学效果。方法：回顾性分析泸州医学院附属医院2008 年6月~2010 年6 月间行PPH 术（P 组48 例）与M-M 术（M 组52 例）符合纳入标准的100 例患者的临床资料。对两组的近、远期疗效，患者满意度，术中、术后并发症进行统计分析，并运用卫生经济学方法分析其成本效果。结果：两组近期疗效无明显差异，但P 组在手术时间、住院时间、恢复工作时间、疼痛持续时间、出血情况，术后疼痛、肛门水肿等方面明显优于M 组（P＜0.05）；M 组远期疗效及成本效果比明显优于P 组（P＜0.05），两组不良反应发生率无明显差异。结论：传统外剥内扎术治疗环状混合痔有较好的近、远期临床疗效，成本效益好，仍是治疗环状混合痔的较佳术式。

Clinical Effect Observation and Cost-effectiveness Analysis on Different Operation Types of Ring Mixed Hemorrhoids Treatment

This study was aimed to compare clinical effect and safety of ring mixed hemorrhoids treatment with procedure for prolapsed and hemorrhoids (PPH) and Milligan-Morgan (M-M) in order to evaluate their effects of health economics. Retrospective analysis was given on clinical data of 100 cases (including 48 cases in P group, 52 cases in M group) which met the inclusion criteria from June 2008 to June 2010 in the Affiliated Hospital of Luzhou Medical College. Statistical analysis was made on short- and long-term effect, patient satisfaction, perioperative and postoperative complications of two groups. The cost-effectiveness was analyzed with the effect of health economics methods. The results showed that there was no obvious difference on short-term effect between two groups. However,aspects such as surgery time, hospitalization time, back to work time, duration of pain, bleeding condition, postoperative pain and anal swelling in P group were significantly better than M group (P < 0.05); long-term effect and costeffectiveness in M group were obviously better than P group (P < 0.05). There was no obvious difference on incidence rate of adverse reaction between two groups. It was concluded that the traditional external dissection and internal ligation for circumferential mixed hemorrhoids had better clinical effect of both short- and long-term with better cost-effectiveness. It is still a better surgical treatment for circular mixed hemorrhoids.