吻合器痔上黏膜环切术加外痔切除术治疗重度混合痔的效果

目的 通过比较PPH加外痔切除术与传统外剥内扎术治疗重度混合痔的临床治疗效果，探索更好的混合痔手术治疗方法。 方法 对2004年12月至2006年9月期间我院肛肠科收治的100例需手术治疗的重度混合痔（Ⅲ~Ⅳ度）患者随机分为实验组和对照组各50例，实验组行PPH加外痔切除术治疗，对照组行外剥内扎术治疗。并对两组病例的手术时间、住院时间、恢复工作时间、术后疗效、术后并发症（包括疼痛、出血、尿潴留、伤口水肿、肛门坠胀、排便困难、控便失调、肛门狭窄）等方面进行比较分析。 结果 两种手术方式疗效相当。在术后24h内疼痛指数、术后出血、尿潴留、肛门坠胀、排便困难及控便失调方面两组的差异无显著性意义。在术后排便时及术后一周的疼痛程度、伤口水肿、肛门狭窄、手术时间、住院时间及恢复工作时间方面实验组优于对照组。 结论 PPH加外痔切除术对有明显外痔的重度混合痔不失为一种安全有效的治疗方法，同传统的外剥内扎术相比，PPH加外痔切除术具有手术时间短、恢复快、术后并发症少、保护肛门控便能力等优点，但其费用较贵、远期疗效尚不明确，临床应根据具体情况选择手术方式。

Procedure for Prolapse and hemorrhoids(PPH) combined external hemorrhoid dectomy versus Milligan-Morgan haemorrhoidectomy:a randomized controlled trial

Objective To research the surgery treatment of severe mixed hemorrhoids (Ⅲ-Ⅳdegree) in clinic. Compare the outcome of procedure for prolapse and hemorrhoids（PPH）combined external hemorrhoid dectomy with Milligan-Morgan hemorrhoidectomy in a randomized controlled trial. And except to evaluate its curative effect of PPH combined external hemorrhoid dectomy correctly and search a best method to treat mixed hemorrhoids. Methods 100 patients admitted for surgical treatment of mixed hemorrhoids(Ⅲ-Ⅳdegree) between December 2004 and September 2006, were randomly assigned to two groups: PPH combined external hemorrhoid dectomy (50 cases) and Milligan-Morgan haemorrhoidectmy (50 cases). Compare and analyze the details of the operating time, hospitalization time, recovery time, efficacy, postoperative complications such as pain, bleeding, urine retention , wound edema, anus discomfortable, constipation, anal incontinence, anal stenosis and etc. Result There is no statistically difference between the two groups' efficacy，postoperatic pain index in 24h，bleeding, urine retention, anus discomfortable, constipation and anal incontinence. Compared with the Milligan-Morgan group, the PPH group had less pain when defecating, less pain after a week, less wound edema, less anal stenosis，shorter operating time, shorter hospitalization time and recovery time. Conclusion PPH combined external hemorrhoid dectomy is a safe and effective method to treat severe mixed hemorrhoids (Ⅲ-Ⅳdegree) with the advantages of early recovery, little postoperative complications and no effecting on anal functions. But its cost is much more than conventional haemorrhoidectomy. And its long-dated curative effect is still undefined. The doctors should choose the reasonable kind of operation for the patients in clinic, according to different patients' different conditions.