选择性痔上黏膜切除术、痔上黏膜环切术与外剥内扎术治疗中重度混合痔的效果比较

目的比较吻合器痔上黏膜环切术（PPH）、外剥内扎术（M-M）与选择性痔上黏膜切除术（TST）治疗中重度混合痔的临床效果。 方法回顾性分析2015年1月至2018年12月克拉玛依市独山子人民医院收治的675例中重度混合痔患者资料，按手术方式分为M-M组（238例）、PPH组（185例）、TST组（252例）。比较三组患者一般手术情况，术后疼痛、肛缘水肿、创面出血或渗血等并发症发生率，排便及创面愈合情况，术后1个月时肛门功能、术后6个月时肛门外观平整度及随访期内肛门失禁、肛门漏气漏液发生率。 结果PPH组、TST组术中出血量、住院时间及住院费用、术后疼痛程度、创面愈合时间、恢复正常活动时间以及肛门水肿Ⅱ~Ⅳ度比例、部分失禁发生率、坠胀/排便感发生率均显著低于M-M组（P<0.05），TST组术中出血量、住院时间显著低于PPH组（P<0.05）。首次排便时间、大便情况分度Ⅲ度及肛门外观平整度Ⅲ度比例为TST组2=0.771，P=0.680）。 结论TST治疗中重度混合痔的治愈率与M-M、PPH相当，但在术中出血量、住院时间、术后排便、肛门外观平整度等方面优势更显著，值得临床推广。

Effect comparison of tissue-selecting therapy,procedure for prolapse and haemolxhoids and milligant-morgant hemorrhoidectom in the treatment of moderate-to-severe mixed hemorrhoids

ObjectiveTo compare the clinical effects of milligant-morgant hemorrhoidectomy (M-M),procedure for prolapse and hemorrhoids (PPH) and tissue-selecting therapy (TST) in the treatment of moderate-to-severe mixed hemorrhoids. MethodsSix hundred and seventy-five patients with moderate-to-severe mixed hemorrhoids who were admitted from January 2015 to December 2018 in Dushanzi People’s Hospital in Karamay City were divided into group M-M (238 cases), group PPH (185 cases) and group TST (252 cases) according to the surgical methods. The general surgery, postoperative pain, anal edge edema, wound hemorrhage or oozing, defecation and wound healing, incidence rate of postoperative complications, anal function at 1 month after surgery, anal appearance flatness at 6 months after surgery, incidence rates of anal incontinence and anal air and liquid leakage during follow-up were compared among the three groups. ResultsCompared to group M-M, the intraoperative blood loss, hospital stay and hospitalization cost, postoperative pain, wound healing time and recovery time, degree of anal edema, incidence of partial incontinence and defecation sensation in group PPH and group TST were significantly lower (P<0.05). The intraoperative blood loss and hospital stay in group TST were significantly lower than those in groupPPH (P<0.05). The first defecation time, the proportion of degree Ⅲ of stool condition and anal appearance flatness both showed group TST < group PPH < group M-M (P<0.05). There were no significant differences in follow-up time, recurrence rate and no-recurrence survival time among the three groups (χ²=0.771, P=0.680). ConclusionTST has similar cure rate as M-M and PPH in the treatment of moderate-to-severe mixed hemorrhoids, but it has more significant advantages in intraoperative blood loss, hospital stay and anal appearance flatness, so as to be worthy of clinical attention.