分段外剥内扎改良术治疗环状混合痔62例临床症状及体征评价

目的:观察分段外剥内扎加括约肌单点浅切改良术式对环状混合痔患者术后症状和体征的影响。方法:选择符合观察条件的环状混合痔患者123例,随机分为治疗组62例、对照组61例;对照组采用分段外剥内扎法,治疗组加括约肌单点浅切法。观察两组患者术后水肿程度及创面愈合时间,跟踪肛门狭窄及肛门失禁的发生情况;定期监测肛门测压相关指标。结果:术后治疗组患者的创面水肿程度、肛门狭窄程度积分均显著低于对照组(P0.05),而创面愈合时间两组无明显差异(P0.05);治疗组的直肠静息压、肛管静息压、肛管舒张压均明显低于对照组(P0.05或P0.01),肛管最大收缩压与对照组相当(P0.05),而直肠初始阈值组间无明显差异(P0.05)。两组患者均未出现肛门失禁、继发感染。结论:分段外剥内扎加括约肌单点浅切术式可显著改善患者临床症状,降低术后肛门狭窄的风险,有效保护肛管直肠压力。

Evaluation on Clinical Symptoms and Signs in 62 Cases of Annular Mixed Hemorrhoids Treated with Improved Segmented Milligant-Morgant Hemorrhoidectomy

  Objective:To observe the effects of segmented milligant-morgant hemorrhoidectomy combined with single-point and shallow sphincterotomy on the postoperative symptoms and signs of patients with annular mixed hemorrhoids.   Methods: A total of 123 patients with annular mixed hemorrhoids who met the observation criteria were selected and randomly divided into the treatment group (62 cases) and control group (61 cases). The control group was only treated with segmented milligant-morgant hemorrhoidectomy,the treatment group was treated with segmented milligant-morgant hemorrhoidectomy combined with single-point and shallow sphincterotomy. The degree of edema, the time of wound healing, the occurrence of anal stenosis and anal incontinence were observed in both groups after operation, and the related indexes of anus manometry were monitored regularly.   Results: After operation,the scores of the degree of wound edema and anal stenosis in the treatment group were significantly lower than those in the control group (P<0.05),but there was no significant difference on the wound healing time between the two groups(P>0.05). The rectal resting pressure, anal canal resting pressure and anal canal diastolic pressure in the treatment group were significantly lower than those in the control group (P<0.05 or P<0.01),the anal maximal contraction pressure in the treatment group was comparable to that in the control group (P>0.05),but there was no significant difference on the rectal initial threshold between the two groups (P>0.05). No anal incontinence and secondary infection were found in both groups.   Conclusion: The segmented milligant-morgant hemorrhoidectomy combined with single-point and shallow sphincterotomy can significantly improve the clinical symptoms of patients,reduce the risk of postoperative anal stenosis and effectively protect the anorectal pressure.