齿状线黏膜浅肌层荷包缝合联合吻合器痔上黏膜环切钉合术治疗Ⅲ期Ⅳ期痔疮对照研究

目的探讨齿状线上2.5 cm-4.0 cm处黏膜浅肌层荷包缝合联合吻合器痔上黏膜环切钉合术治疗Ⅲ期、Ⅳ期痔疮患者的临床效果.方法将140例Ⅲ期、Ⅳ期痔疮患者按手术方法不同分为实验组70例,对照组70例,两组均行吻合器痔上黏膜环切钉合术治疗,对照组予以齿状线上2.5cm内不带肌层黏膜荷包缝合术治疗,实验组予以齿状线上2.5 cm-4.0 cm处黏膜浅肌层荷包缝合术治疗,术后随访3个月.比较两组临床疗效、手术情况、住院时间、并发症发生率、直肠顺应性、肛门功能.结果(1)两组总有效率均达100%,但实验组治愈率(97.1%)显著高于对照组(77.1%)(P<0.01);(2)实验组手术对间、住院时间显著短于对照组(P<0.01),环状黏膜组织完全切陈率(98.6%)显著高于对照组(87.1%)(P<0.01);(3)两组直肠顺应性比较差异无统计学意义(P>0.05);(4)术后3个月两组肛管静息压、肛管最大收缩压均较术前有不同程度降低,但组内及组间比较差异无统计学意义(P>0.05);(5)实验组并发症发生率(5.7%)显著低于对照组(18.6%)(P<0.05).结论齿状线上2.5 cm-4.0 cm处黏膜浅肌层荷包缝合联合吻合器痔上黏膜环切钉合术治疗Ⅲ期、Ⅳ期痔疮患者效果显著,对直肠顺应性及肛门功能无影响,且手术操作简便,并发症发生率较低,有利于促进患者的康复.

Follow-up study on patients with stage Ⅲ-Ⅳ hemorrhoids treated by purse suture of superficial muscular layer of mucosa of dentate line combined with PPH

Objective To explore the clinical effect of purse suture of superficial muscular layer of mucosa at 2.5 cm to 4.0 cm of dentate line combined with PPH in the treatment of stage Ⅲ-Ⅳ hemorrhoids.Methods 140 patients with stage Ⅲ-Ⅳ hemorrhoids were divided into experimental group(n=70)and control group(n=70)according to the operation method.PPH was performed in both groups.The control group was treated with purse suture of superficial muscular layer of mucosa without muscular layer within 2.5 cm of dentate line,while the experimental group was treated with purse suture of superficial muscular layer at 2.5 cm to 4.0 cm.Patients were followed up for 3 months.The curative effect,operation condition,hospitalization time,incidence of complications,rectal compliance and anal function were compared between the two groups.Results(1)The total effective rate of the two groups was 100%.The cure rate of the experimental group was 97.1%,higher than that of the control group(77.1%)(P<0.01).(2)The operation time and hospitalization time of the experimental group were shorter than those of the.control group(P<0.01),and the complete removal rate of circular mucosa tissue was 98.6%,higher than that of the control group(87.1%)(P<0.01).(3)There was no significant difference in rectal compliance between the two groups(P>0.05).(4)The maximum systolic pressure and resting pressure of the anal canal in the two groups decreased in varying degrees three months after operation,but there was no significant difference between the two groups and within the group(P>0.05).(5)The incidence of complications in the experimental group was 5.7%,lower than that in the control group(18.6%)(P<0.05).Conclusions Stage Ⅲ-Ⅳ hemorrhoids are treated with purse suture of superficial mucosal muscle layer at 2.5 cm to 4.0 cm of dentate line combined with PPH.The curative effect is remarkable.It does not affect rectal compliance and anal function.The operation is simple and the complications are few,which can also promote prognosis reha bilitation.