CAJ | 학술논문

目的比较直针手缝痔固定术(straight-needle hand-sewing heamorroidpexy,HHP)和直肠黏膜环切术(procedure for prolapse and heamorroids,PPH)治疗Ⅲ～Ⅳ度痔的近期及远期临床疗效.方法按完全随机对照分组原则将800例Ⅲ～Ⅳ度痔分为HHP术组(385例)和PPH术组(415例),观察并比较两组患者术后近期及远期临床效果.数据采用t检验及x2检验.结果手术时间HHP组(35.1 ±6.2)min,PPH组(20.7±5.1)min;住院时间HHP组(4.8±2.2)d,PPH组(5.5±2.1)d,两组比较差异无统计学意义.术后疼痛采用视觉模拟评分(visual analogue scale,VAS)(≥5分为重度疼痛),≥5分者HHP组45例(占12.1％)；PPH组128例(占31.8％)；术后平均恢复工作生活时间,HHP组(5.2±2.3)d,PPH组(10.2±2.4)d；术后并发症(包括出血、痔核突出及吻合口狭窄等需要再次手术者),HHP组5例(0.01％),PPH组17例(0.51％)；住院总费用HHP组平均为3520.2元,PPH组平均为8925.2元；患者满意度,HHP组93.9％,PPH组83.1％.统计学分析在近期疗效各指标中,HHP组均明显优于PPH组.术后随访2～5年,HHP组随访278例,PPH组随访292例.术后需要再次手术者中,便血HHP组17例(6.1％),PPH组44例(15.1％)；痔核脱出HHP组12例(4.3％),PPH组52例(17.8％),两组比较差异亦有统计学意义(x2 =4.25,P＜0.05).在排便功能方面(如排便感觉异常、便秘、便急或大便失禁等)两组无明显差异.结论与PPH术相比,HHP术具有安全、痛苦小、费用低、并发症少及患者满意度高等优点,值得推广.
목적 비교직침수봉치고정술(straight-needle hand-sewing heamorroidpexy,HHP)화직장점막배절술(procedure for prolapse and heamorroids,PPH)치료Ⅲ～Ⅳ도치적근기급원기림상료효.방법 안완전수궤대조분조원칙장800례Ⅲ～Ⅳ도치분위HHP술조(385례)화PPH술조(415례),관찰병비교량조환자술후근기급원기림상효과.수거채용t검험급x2검험.결과 수술시간HHP조(35.1 ±6.2)min,PPH조(20.7±5.1)min;주원시간HHP조(4.8±2.2)d,PPH조(5.5±2.1)d,량조비교차이무통계학의의.술후동통채용시각모의평분(visual analogue scale,VAS)(≥5분위중도동통),≥5분자HHP조45례(점12.1％)；PPH조128례(점31.8％)；술후평균회복공작생활시간,HHP조(5.2±2.3)d,PPH조(10.2±2.4)d；술후병발증(포괄출혈、치핵돌출급문합구협착등수요재차수술자),HHP조5례(0.01％),PPH조17례(0.51％)；주원총비용HHP조평균위3520.2원,PPH조평균위8925.2원；환자만의도,HHP조93.9％,PPH조83.1％.통계학분석재근기료효각지표중,HHP조균명현우우PPH조.술후수방2～5년,HHP조수방278례,PPH조수방292례.술후수요재차수술자중,편혈HHP조17례(6.1％),PPH조44례(15.1％)；치핵탈출HHP조12례(4.3％),PPH조52례(17.8％),량조비교차이역유통계학의의(x2 =4.25,P＜0.05).재배편공능방면(여배편감각이상、편비、편급혹대편실금등)량조무명현차이.결론 여PPH술상비,HHP술구유안전、통고소、비용저、병발증소급환자만의도고등우점,치득추엄.
Objective To compare the short-term and long-term results of hand-sewing heamorroidpexy(HHP) and procedure for prolapse and heamorroids(PPH) in the treatment of grade Ⅲ and Ⅳ heamorrhoids.Methods Eight hundred patients were randomly divided into two groups receiving PPH (n =415) and HHP( n =385 ) respectively.The operative result including postoperative pain,prolapse,total expense,time to return normal work,percentage of satisfaction and other complications were compared between the two groups.Result The time of resuming normal work in HHP group was (5.2±2.3) d,in PPH group was ( 10.2 ±2.4) d,P =0.038.Postoperative visual analogue scale ≥5 was found in 45 cases ( 12.1％ ) in HHP group,and in 128 cases(31.8％ ) in PPH group,P =0.018.HHP group was superior to PPH group in patients' satisfaction,inhospital cost,complications,and recurrence,all P ＜ 0.05.Patients were followed up for more than 2 years,long term complication of bleeding,prolapse and anastomtic structure developed less frequently in HHP group than in PPH group (x2 =4.25,P ＜ 0.05 ).Conclusions HHP is a safe and effective treatment for heamorroids(gradeⅢ - Ⅳ ) with the advantages of less postoperative pain,quicker recovery,lower expenses,shorter hospital stay and higher satisfactory rate.