悬吊绑缚动脉结扎切除闭合术联合敛痔散外敷治疗重度混合痔疗效观察

目的观察悬吊绑缚动脉结扎切除闭合术联合敛痔散外敷治疗重度混合痔的临床疗效。方法将2017年12月—2019年7月在上海市金山区中西医结合医院治疗的80例重度混合痔患者随机分为治疗组与对照组各40例,最终治疗组39例、对照组37例完成全部试验。对照组采用内套外剥保留齿线术治疗,治疗组采用悬吊绑缚动脉结扎切除闭合术治疗,2组自术后第1天起均采用敛痔散外敷换药。观察并比较2组患者的临床疗效、手术时间、住院时间、创面愈合时间、术后并发症发生情况及肛门功能评分情况。结果治疗组治愈37例(94.9%),对照组治愈34例(91.9%),2组疗效比较差异无统计学意义(P>0.05)。治疗组手术时间、住院时间、创面愈合时间均明显短于对照组(P均<0.05)。术后第1天和第3天,治疗组肛门疼痛程度均明显轻于对照组(P均<0.05),肛缘水肿、便血发生率均明显低于对照组(P均<0.05);术后24 h内,治疗组尿潴留发生率明显低于对照组(P<0.05)。2组创面愈合时和术后6个月门诊随访时的肛门功能评分均明显低于术前(P<0.05),2组间各观察时间点的肛门功能评分比较差异均无统计学意义(P均>0.05)。术后6个月门诊随访,2组均无肛门失禁发生,2组皮赘残留率、复发率、肛门狭窄率比较差异均无统计学意义(P均>0.05)。结论悬吊绑缚动脉结扎切除闭合术联合敛痔散外敷治疗重度混合痔可缩短住院时间,促进创面更快愈合,降低术后并发症发生率。

Observation on the curative effect of dearterialization rectopexy and closed hemorrhoidectomy combined with external application of Lianzhisan on severe mixed hemorrhoids

Objective It is to observe the clinical effect of the treatment of severe mixed hemorrhoids by dearterialization rectopexy and closed hemorrhoidectomy combined with external application of Lianzhisan.Method 80 patients with severe mixed hemorrhoids treated in Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine from December 2017 to July 2019 were randomly divided into treatment group and control group,with 40 cases in each group.Finally,39 cases in the treatment group and 37 cases in the control group completed all the tests.The control group was treated with internal sleeve and external stripping and reservation of dentate thread,and the treatment group was treated by dearterialization rectopexy and closed hemorrhoidectomy.Since the first day after operation,Lianzhi powder was applied for dressing change in both groups.The clinical efficacy,operation time,hospitalization time,wound healing time,postoperative complications and anal function score of the two groups were observed and compared.Results 37 cases(94.9%)were cured in the treatment group and 34 cases(91.9%)in the control group.There was no significant difference in the curative effect between the two groups(P>0.05).The operation time,hospitalization time and wound healing time of the treatment group were shorter than those of the control group(all P<0.05).On the 1st and 3rd day after operation,the anal pain in the treatment group was significantly lighter than that in the control group(all P<0.05),and the incidence of anal edema and hematochezia in the treatment group was significantly lower than that in the control group(all P<0.05).The incidence of urinary retention in the treatment group was significantly lower than that in the control group within 24 hours after operation(P<0.05).The anal function scores at wound healing and 6-month follow-up were significantly lower than those before operation in the two groups(all P<0.05).There was no significant difference in anal function scores between the two groups at each observation time point(all P>0.05).Outpatient follow-up of 6 months after operation,no anal incontinence occurred in both groups.There was no significant difference in the residual rate,recurrence rate and anal stenosis rate between the two groups(all P>0.05).Conclusion Dearterialization rectopexy and closed hemorrhoidectomy combined with external application of lianzhisan can shorten the hospitalization time,accelerate the wound healing and reduce the incidence of postoperative complications in the treatment of severe mixed hemorrhoids.