CAJ | 학술논문

目的探讨多重定位吻合器痔上黏膜环切术(PPH)治疗结缔组织型混合痔的效果,并与Milligan-Morgan术进行比较.方法将116例结缔组织型混合痔患者按随机数字表法分为治疗组(62例)和对照组(54例).治疗组采用多重定位PPH,对照组采用Milligan-Morgan术,观察两组在手术时间、术中出血量、术后疼痛评分、肛缘水肿、切口愈合时间、肛周瘢痕、肛管直肠狭窄、肛门溢液、肛管直肠压力测定等方面的差异.结果治疗组手术时间和术中出血量均低于对照组[(15.0±2.3) min比(35.0±3.4) min,(5.0±2.1)ml比(15.0±3.2)ml],差异有统计学意义(P＜0.05).治疗组术后疼痛评分及切口愈合时间低于对照组[(4.83±0.62)分比(7.82±0.37)分,(8.2±2.6)d比(17.4±3.8)d],肛缘水肿、肛周瘢痕、肛管直肠狭窄发生率低于对照组[8.1％(5/62)比37.0％(20/54)、0比29.6％(16/54)、1.6％(1/62)比16.7％(9/54)],差异有统计学意义(P＜0.05或＜0.01).对照组术后肛管静息压较术前降低[(13.80±4.20) kPa比(17.20±5.87)kPa],差异有统计学意义(P＜0.05).治疗组术后肛门溢液1例(1.6％,1/62),对照组肛门溢液10例(18.5％,10/54),治疗组术后肛门溢液发生率低于对照组,差异有统计学意义(P＜0.01).结论多重定位PPH治疗结缔组织型混合痔增加了切除部位、切除量的可控性,减少了肛缘水肿、肛周瘢痕和肛门溢液的发生,可有效保护肛门功能,增加患者满意度.
목적 탐토다중정위문합기치상점막배절술(PPH)치료결체조직형혼합치적효과,병여Milligan-Morgan술진행비교.방법 장116례결체조직형혼합치환자안수궤수자표법분위치료조(62례)화대조조(54례).치료조채용다중정위PPH,대조조채용Milligan-Morgan술,관찰량조재수술시간、술중출혈량、술후동통평분、항연수종、절구유합시간、항주반흔、항관직장협착、항문일액、항관직장압력측정등방면적차이.결과 치료조수술시간화술중출혈량균저우대조조[(15.0±2.3) min비(35.0±3.4) min,(5.0±2.1)ml비(15.0±3.2)ml],차이유통계학의의(P＜0.05).치료조술후동통평분급절구유합시간저우대조조[(4.83±0.62)분비(7.82±0.37)분,(8.2±2.6)d비(17.4±3.8)d],항연수종、항주반흔、항관직장협착발생솔저우대조조[8.1％(5/62)비37.0％(20/54)、0비29.6％(16/54)、1.6％(1/62)비16.7％(9/54)],차이유통계학의의(P＜0.05혹＜0.01).대조조술후항관정식압교술전강저[(13.80±4.20) kPa비(17.20±5.87)kPa],차이유통계학의의(P＜0.05).치료조술후항문일액1례(1.6％,1/62),대조조항문일액10례(18.5％,10/54),치료조술후항문일액발생솔저우대조조,차이유통계학의의(P＜0.01).결론 다중정위PPH치료결체조직형혼합치증가료절제부위、절제량적가공성,감소료항연수종、항주반흔화항문일액적발생,가유효보호항문공능,증가환자만의도.
Objective To explore the effect of multiple positioning procedure for prolapse and hemorrhoids (PPH) in treatment of connective tissue type mixed hemorrhoids,and compare the results between PPH and Milligan-Morgan surgery.Methods One hundred and sixteen patients with connective tissue type mixed hemorrhoids were divided into treatment group (62 cases) and control group (54 cases)according to random digits table method.The patients in treatment group received multiple positioning PPH,and the patients in control group received Milligan-Morgan surgery.The operative time,intraoperative blood loss,postoperative pain score,anal margin edema,wound healing time,perianal scar,anorectal stenosis,anal discharge and anorectal resting pressure were evaluated and compared between 2 groups.Results The operative time and intraoperative blood loss in treatment group were significantly lower than those in control group:(15.0 ± 2.3) min vs.(35.0 ± 3.4) min and (5.0 ± 2.1) ml vs.(15.0 ± 3.2) ml,and there were statistical differences (P ＜ 0.05).The postoperative pain score and wound healing time in treatment group were significantly lower than those in control group:(4.83 ± 0.62) scores vs.(7.82 ± 0.37) scores and (8.2 ± 2.6) d vs.(17.4 ± 3.8) d,the rates of anal margin edema,perianal scar and anorectal stenosis in treatment group were significantly lower than those in control group:8.1％ (5/62) vs.37.0％ (20/54),0 vs.29.6％ (16/54) and 1.6％(1/62) vs.16.7％ (9/54),and there were statistical differences (P ＜ 0.05 or ＜ 0.01).The postoperative anorectal resting pressure was significantly lower than preoperative in control group:(13.80 ± 4.20) kPa vs.(17.20 ± 5.87) kPa,and there was statistical difference (P＜ 0.05).One patient (1.6％,1/62) in treatment group occurred anal discharge,and 10 patients (18.5％,10/54) occurred anal discharge in control group.The rate of anal discharge in treatment group was significantly lower than that in control group,and there was statistical difference (P ＜ 0.01).Conclusions Multiple positioning PPH is effective for the treatment of connective tissue type mixed hemorrhoids.It improves the controllability of the amount of removal and the excision site.It decreases the incidence of anal margin edema,perianal scar and anal discharge scar,which provides an effective protection for the anal function.