吻合器痔上黏膜环切术联合外剥内扎手术治疗Ⅲ-Ⅳ度环状混合痔的疗效及对患者肛门功能的影响

目的:研究吻合器痔上黏膜环切术(PPH)联合外剥内扎手术(MMH)治疗Ⅲ-Ⅳ度环状混合痔的疗效及对患者肛门功能的影响。方法:选择2016年3月~2018年3月我院收治的III-IV度环状混合痔患者128例为研究对象,将入选患者按照随机数字表法分为MMH组(n=58,采用MMH治疗)和联合组(n=70,采用PPH联合MMH治疗),比较两组手术指标及术后恢复情况,术后对两组患者进行为期3个月的随访,随访结束后,比较两组治疗疗效、肛门功能以及并发症的发生情况。结果:与MMH组比较,联合组手术出血量明显更少,住院时间、伤口愈合时间明显更短,各时间点的疼痛评分明显降低(P0.05)。与MMH组比较,联合组治疗总有效率升高,差异有统计学意义(P0.05)。与MMH组比较,联合组患者肛管静息压、肛管高压带长度、直肠肛门抑制反射阳性率均升高,肛管最大收缩压降低(P0.05),但两组直肠静息压比较差异无统计学意义(P0.05)。联合组并发症发生率为10.00%(7/70),低于MMH组的34.48%(20/58),差异有统计学意义(P0.05)。结论:较传统的MMH单独治疗,PPH联合MMH治疗Ⅲ-Ⅳ度环状混合痔具有更好的效果,可以缩短术后恢复时间,改善术后疼痛程度及肛门功能,且安全性较高。

Curative Effect of Procedure for Prolapse and Hemorrhoids Combined with Milligan-morgan Haemorrhoidectomy in Treatment of III-IV Degree Mixed Hemorrhoids and Its Effect on Anal Function of Patients

ABSTRACT Objective: To study curative effect of procedure for?prolapse and hemorrhoids (PPH) combined with milligan-morgan haemorrhoidectomy(MMH) in treatment of III-IV degree mixed hemorrhoids and its effect on anal function of patients. Methods: 128 patients with III-IV degree mixed hemorrhoids who were treated in our hospital from March 2016 to March 2018 were selected as research object, the enrolled patients were divided into MMH group (n=58, treated with MMH) and combined group (n=70, treated with PPH combined with MMH) according to random number table method. Operation indexes and postoperative recovery of two groups were compared. The patients in the two groups were followed up for 6 months after operation. After the end of the follow-up, the curative effect, anal function and complications of the two groups were compared. Results: Compared with the MMH group, surgical bleeding volume in the combined group was significantly less, hospital stay, wound healing time were shorter, and the pain scores at each time point were significantly lower(P<0.05). Compared with group MMH, the total effective rate of combined group was significantly increased,and the difference was statistically significant(P<0.05). Compared with MMH group, the anal canal resting pressure, the length of anorectal hyperbaric zone and anorectal reflex positive rate in the combined group were significantly increased, anal maximum systolic pressure was decreased(P<0.05), however, there was no significant difference in rectal resting pressure between the two groups (P>0.05). The incidence of complications in the combined group was 10.00% (7/70), which was significantly lower than 34.48%(20/58) in the MMH group, and the difference was statistically significant (P<0.05). Conclusion: Compared with the traditional MMH treatment alone, PPH combined with MMH has better effect in the treatment of III-IV degree mixed hemorrhoids.It can shorten postoperative recovery time, improve postoperative pain level and anal function, and it has higher safety.