改良Milligan-Morgan术与PPH术治疗环状混合痔的临床探讨

目的探讨改良Milligan-Morgan术和PPH术治疗环状混合痔的临床疗效。方法将72例环状混合痔患者在知情同意后,随机分为2组,每组36例,分别采用改良Milli-gan-Morgan术(M-M组)和PPH术(PPH组)。比较2组治疗后症状(便血、脱出、疼痛)、术后并发症(出血、疼痛、水肿、尿潴留、下腹不适、肛门坠胀、复发)、住院时间、住院费用及术后0.5~1 a随访结果。结果①每组治疗前后症状比较有显著性差异(P0.05),2组间治疗前症状比较无显著性差异(P0.05),便血、脱出、总分比较无显著性差异。术后疼痛PPH组优于M-M组(P0.05),水肿、尿潴留、肛门坠胀、术后出血和复发2组比较无显著性差异,但下腹不适M-M组优于PPH组(P0.05)。②住院时间PPH组优于M-M组(P0.05),住院费用M-M组优于PPH组(P0.05)。③满意率调查M-M组94%,PPH组86%。结论M-M组和PPH组均能有效治疗环状混合痔。通过改进凭其确切疗效,少有并发症,低费用,Milligan-Morgan术式仍是环状混合痔手术治疗的首要选择。尽管PPH术是一项治疗痔的新技术,但PPH术有其严格的临床适应证并且存在严重并发症,要它代替目前可获较佳近期和远期疗效的Milligan-Morgan术还需要体现其优越性。

Clinical approach of improvement Milligan-Morgan operation and PPH operation on circular mixed hemorrhoid

Objective It is to approach the clinical curative effect of modified Milligan-Morgan(M-M) operation and PPH operation on circular mixed hemorrhoid.Methods 72 patients with circumferential mixed hemorrhoids were randomly grouped to receive either modified M-M(M-M group) or PPH(PPH group) to compare preoperative and postoperative symptoms such as bleeding,prolapse and pain in each group and between the two groups.Hospitalization time,hospitalization expenses,follow-up results and postoperative complications such as bleeding,pain,wound edema,urinary retention,lower abdomen discomfort,anal discomfort feeling and recurrence were also recorded.Results ① Preoperative and postoperative symptoms in each group had significant differences(P<0.05),while there were no statistical differences between two groups.Pain after operation of PPH was lower than that of M-M(P<0.05).There was no significant difference on wound edema,urinary,anal discomfort feel,bleeding and recurrence between the two groups,while M-M group with lower abdomen discomfort was prior to PPH group(P<0.05).② Hospitalization time in PPH group was shorter than that in M-M group(P<0.05),while hospitalization expenses were much higher than that of the latter(P<0.05).③ Percentage of satisfaction in M-M group was 94% and that in PPH group was 86%.Conclusion Both surgeries have efficiency on circular mixed hemorrhoid.Modified M-M is the first choice for circular mixed hemorrhoid depended on the exact curative effect,niggardly complication and low expense.Although PPH is a new technology to treat hemorrhoids,it has rigorous clinical indications and severe complications.Thus,it needed enough advantages of short-term and long-term efficiency to replace M-M surgery.