痔上黏膜环切钉合术与Milligan-Morgan术治疗重度痔的近远期疗效比较

目的：比较痔上黏膜环切钉合术（PPH）与Milligan—Morgan术（M-M）治疗重度痔的近远期疗效。方法：回顾性分析166例Ⅲ～Ⅳ期重度痔患者的临床资料及5年随访资料，M—M组和PPH组各83例。比较2组患者的近期疗效、远期并发症及复发情况。结果：2组手术时间、住院时间、住院费用、疼痛指数及术后近期并发症发生率差异有统计学意义（P〈0．05～P〈0．01）。III期患者中，PPH组术后3年、5年复发率与M—M组差异无统计学意义（P〉0．05）。Ⅳ期患者中，PPH组术后3年、5年并发症发生率和术后5年的复发率均高于M—M组（P〈0．05）。结论：PPH治疗Ⅲ、Ⅳ期重度痔的近期疗效优于M-M，但远期并发症及复发率较高。对于Ⅲ期脱垂性内痔或以内痔为主的混合痔宜选择PPH治疗，而对于Ⅳ期重度痔及以外痔为主的混合痔则应考虑以M—M进行治疗。

The short- and long-term effect comparsion of procedure for prolapsed hemorrhoid and Milligan-Morgan hemorrhoidectomy in the treatment of severe hemorrhoids

Objective：To compare the short- and long-term effects of procedure for prolapsed and hemorrhoid（PPH） and Milligan- Morgan hemorrhoidectomy（M-M） in the treatment of severe hemorrhoids. Methods：One hundred and sixty-six patients with grade ]]] and IV hemorrhoids were followed up for 5 years,and divided into PPH and M-M group（83 cases each group）. The short-term effects, long-term complications and recurrence in two groups were compared. Results： The differences of the time of operation and hospitalization stay,hospitalization expense, pain index and incidence of short-term complication between PPH and M-M group were statistically significant（P 〈 0.05 to P 〈 0.01 ）. The differences of the recurrence rates between PPH group and M-M group with grade III in 3 and 5 years after operation had no statistical significance （ P 〈 0. 05 ）. The recurrence rate of 5 years after operation and incidence of complications of 3 and 5 years after operation in PPH group with grade IV were higher than those in M-M group （ P 〈 0.05）. Conclusions ：The short-term effects of PPH in the treatment of grade III and IV hemorrhoids are better than those in M-M group, but their long-term complications and recurrence rates are high. The PPH treatment is fit for the patients with grade m prolapsed internal hemorrhoids and mixed hemorrhoid which is mainly composed of internal hemorrhoids. The M-M treatment is fit for the patients with grade IV hemorrhoids and mixed hemorrhoid which is mainly composed of external hemorrhoids.