PPH与外剥内扎术的对比观察

目的探讨吻合器痔上黏膜环切钉合术（PPH）治疗环状脱垂痔的临床效果。方法将100例环状脱垂痔随机分组进行黏膜环切钉合术（PPH）和外剥内扎术（MMH）治疗，每组50例对比观察2组手术时间、创面愈合时间、住院时间、术后疼痛指数、肛门功能测定、患者满意度、术后并发症等指标。结果与MMH相比，PPH在缩短手术时间、创口愈合时间和住院时间，减轻术后疼痛及术后满意度等方面有明显优势（P〈0．001）。但术后残留皮赘，痔回缩不全更为常见。结论PPH在治疗环状脱垂痔方面有缩短手术时间、创口愈合时间和住院时间，减轻术后疼痛等特点，术后满意度明显优于MMH，但在术后残留皮赘痔脱垂回缩方面不如MMH。PPH最佳适应症为三度脱垂性内痔及以内痔为主的脱垂性混合痔。外痔为主的环状混合痔从术后残留皮赘及痔回复不全方面考虑仍以MMH手术为佳。

Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Haemorrhoidectomy:a Randomized Controlled Trial

Objective To evaluate the efficacy of procedure for prolapse and hemorrhoids （PPH） in the treatment circumferential prolapsed hemorrhoids （CPH）. Methods One hundred patients with CPH were randomly divided into PPH （ n = 50, received procedure for prolapse and hemorrhoids） and MM H group （ n = 50, received Milligan-Morgan haemorrhoideetomy）. The operating time, healing time of wound surface, hospital stay, pain scores, anal discharge, postoperative complication and satisfaction of patients were compared. Results PPH had an ascendancy over MMH in operating time, hospital stay, pain, anal discharge and patients satisfaction （ P 〈 0.001 ）. However, acrochordons and prolapse were more common in PPH group. Conclusions The curative effect of PPH is better in terms of average operative duration of time, visual analogue scale of pain, average hospitalization days,postoperative work resumption days, etc. There was reasonably clear evidence in favor of MMH for acrochordons and prolapse. In our opinion the cases of the mixed hemorrhoid of main external hemorrhoids are the right for MMH. The cases of prolapsed internal hemorrhoids and mixed hemorrhoid of main internal hemorrhoids are right case for PPH.