保留齿状线分段外切内注术治疗结缔组织型环状混合痔的随机试验

 目的探讨一种治疗结缔组织型环状混合痔新的手术方法.方法对197例结缔组织型环状混合痔患者进行随机的分组,分别采用保留齿状线分段外切内注术(CRI)和常规外剥内扎术(Milligan-Morgan法,MM)进行治疗,其中CRI组101例,MM组96例.对患者人口统计学及治疗相关细节进行了详细记录,术后对创面愈合时间、并发症、症状缓解、失禁评分及患者满意程度进行评估.结果术后MM组于创面愈合时间大于CRI组.MM组术后疼痛和发生与治疗有关并发症(P＜0.05)高于CRI组.MM组和CRI组术后疗效相同,但MM组增加术后出血的机会(P＜0.05).两组随访至术后6个月,复发率无明显差别(P＞0.05).术后患者肛门控制评分、患者满意度无明显差异(P＞0.05).结论在对结缔组织型环状混合痔治疗采用保留齿状线分段外切内注术,不但能够获得与常规外剥内扎术相同的疗效及患者满意度,而且缩短创面愈合时间、减少术后疼痛的发生,同时由于保持肛门生理结构和功能,减少了并发症的发生.

Randomized trial of a combined therapy cousisting of resection of segmental external hemorrhoids and injection to internal hemorrhoids with retained dentate line

Objective To evaluate a new operation procedure for the tre at ment of circumferential mixed hemorrhoids.Methods 197 patients with circumferential mixed hemorrhoids were randomly allocated to receive either combined therapy(n=101) or Milligan-Morgan therapy (n=96).The two grou ps were equally matched for age,gender,incontinence scores,and quality of life. Patient's demographidata and procedure-related details were recorded.The pati ents were followed up to assess complications,symtom relief,incontinence scores, and patient 's satisfaction.Results The healing time of the oper ative wound in Milligan-Morgan group was longer than that in combined therapy g roup (P<0.05).Combined therapy and Milligan-Morgan therapy were equally ef fective postoperatively,Milligan-Morgan method had higher incidence of postope rative pain and procedure-related complications(P<0.05) and increased incidence of recurrent bleeding(P=0.033).Six-month follow-u p found no si gnificant difference between the two groups in the rate of recurrence (P>0. 05).There was no significant difference between the two groups in terms of anal continence scores and patient's satisfaction.Conclusions The combined therapy of circumferential mixed hemorrhoids consisting of resectio n of segmental exteinal hemorrhoids and injection to inteinal hemorrhoids with re tained dentate line not only has postoperative effectiveness and patient's satis faction equal with those of Milligan-Morgan method,but also shortens healing t ime of the operative wound,reduces pain ,retains better physiological function of anus,and decreases postoperative complications.