吻合器痔上黏膜环形切除术对环状混合痔患者肛门功能及生活质量的影响

目的:比较吻合器痔上黏膜环形切除术(PPH)和外剥内扎手术(MMH)治疗环状混合痔的疗效及对患者肛门功能恢复、生活质量的影响,为临床治疗环状混合痔的术式选择提供依据。方法:选取2016年8月-2018年1月我院收治的84例环状混合痔患者作为研究对象。采用随机数字表法将患者分为PPH组(n=42)和MMH组(n=42)。比较两组患者的疗效、手术及术后恢复情况。随访3个月,观察两组患者的并发症发生情况,并采用生活质量综合评定问卷(GQOL-74)评价两组患者的生活质量变化情况。术后6个月对所有患者进行直肠肛门测压,记录并比较两组测量结果。结果:PPH组患者治疗总有效率为97.62%,高于MMH组的83.33%(P0.05)。两组患者手术时间、创面愈合时间、住院时间及恢复工作时间比较,PPH组均明显短于MMH组(P0.05)。PPH组总并发症发生率为14.29%,低于MMH组的40.48%(P0.05)。术后3个月,两组患者GQOL-74各维度评分均高于术前,且PPH组患者GQOL-74各维度评分均高于MMH组患者(P0.05)。术后6个月,PPH组患者肛管静息压、肛管高压带长度、直肠肛门抑制反射阳性率均明显高于MMH组(P0.05),但两组肛管最大收缩压和直肠静息压比较无统计学差异(P0.05)。结论:PPH治疗环状混合痔疗效确切且兼具较高的安全性,可促进患者的术后恢复,明显改善患者肛门功能和生活质量。

Effect of Procedure for Prolapse and Hemorrhoids on anal Function and Ouality of Life in Patients with Circumferential Mixed Hemorrhoids

ABSTRACT Objective: To compare the effect of procedure for prolapse and hemorrhoids (PPH) and Milligan-morgan haemor- rhoidectomy (MMH) on anal function and quality of life in patients with circumferential mixed hemorrhoids, so as to provide basis for the selection of surgical methods for the treatment of circumferential mixed hemorrhoids. Methods: 84 patients with circumferential mixed hemorrhoids who were treated in our hospital from January 2017 to June 2018 were selected as the research subjects. The patients were divided into PPH group(n=42)and MMH group(n=42) according to random number table method. The efficacy, operation and postopera- tive recovery of the two groups were compared. After 3 months of follow-up, the complications of the two groups were observed, and the quality of life comprehensive assessment questionnaire (GQOL-74) was used to evaluate the quality of life of the two groups. The anorec- tal manometry was performed for all patients at 6 months after operation, recorded and compared the results of measurements of two groups. Results: The total effective rate of PPH group was 97.62%, which was significantly higher than 83.33% of MMH group (P<0.05).The operation time, wound healing time, hospital stay and return to work time of PPH group were significantly shorter than those of MMH group (P<0.05). The incidence of total complications in PPH group was 14.29%, whigh was significantly lower than 40.48% in MMH group (P<0.05). At 6 months after operation, the anal canal resting pressure, the length of anal canal high pressure band and the positive rate of anorectal inhibition reflex in PPH group were significantly higher than those in MMH group (P<0.05). However, there was no significant difference between the two groups in anal systolic pressure and rectal resting pressure (P>0.05). Conclusion: PPH is ef- fective and safe in the treatment of circumferential mixed hemorrhoids.It can promote postoperative recovery and improve anal function and quality of life in patients.