PPH 联合超声刀痔切除在重度混合痔中的临床观察

目的：对照研究吻合器痔上黏膜环切钉合术（PPH）联合超声刀痔切除在治疗重度混合痔的临床效果。方法把40例重度混合痔采用 PPH 环切治疗后仍有回缩不全的外痔、皮赘的患者随机法分为对照组和研究组各20例，研究组应用超声刀痔切除术，对照组采用传统外剥内扎术，观察两组术后疗效情况、手术时间、术中出血量、术后继发性出血、术后24 h 疼痛评分、术后肛缘水肿、创面愈合时间、术后肛门狭窄等临床情况。结果研究组与对照组相比，其中术中出血量、术后出血发生率、手术用时、术后24 h 疼痛评分均有统计学意义（P ＜0．05），且研究组优于对照组；两组在疗效、术后肛缘水肿、创面愈合时间、术后肛门狭窄等方面无统计学意义（P ＞0．05）。结论对于重度环状混合痔行 PPH 环切后痔回缩不全的患者联合使用超声刀痔切除，其疗效可靠，具有术中出血量少、手术用时短、术后疼痛轻等优点，作为一种安全有效且操作方便、术后痛苦小的手术方法，值得临床应用推广。

Observation of PPH & harmonic scalpel hemorrhoidectomy for severe circumferential mixed hemorrhoids

Objective To observe the clinical effects of PPH &harmonic scalpel hemorrhoidectomy for severe circumferential mixed hemorrhoids.Methods A total of 40 severe circumferential mixed hemorroids patients who still had incomplete hemorrhoid retraction after PPH treatment were randomly divided into the control group(20 patients)and the study group(20 patients).The study group was treated with harmonic scalpel hemorrhoidectomy,while the control group was treated with traditional Milligan -Morgan.Curative effects, operation duration,blood loss during operation,bleeding after operation,postoperative 24h pain score,the postoperative perianal edema, wound healing time,postoperative anal stenosis clinical situation were investigated in these two groups.Results There was significant difference in blood loss during operation,operation duration and postoperative 24h pain score between the study group and the control group(P <0.05).The study group was superior to the control group,but no significant differences of curative effect,postoperative peri-anal edema,wound healing time and postoperative anal stenosis were observed(P >0.05).Conclusions Hemorroids patients treated with PPH with hemorrhoids retracted insufficiency,and harmonic scalpel hemorrhoidectomy showed rising clinical curative effects with obvious merits including less blood loss during operation,shorter operation duration and less postoperative pain.Therefore,it is consid-ered as convenient operation with safety,efficacy and less pains,which is worthy of clinic applications.