PPH分别联合超声刀、消痔灵注射术治疗混合痔的临床对比研究

胡丽 黎绍杰

【摘要】 目的 探究吻合器痔上黏膜环切术（PPH）分别联合超声刀、消痔灵注射术治疗混合痔的效果差异。方法 76例混合痔患者， 按隨机数字表法分为A组和B组， 每组38例。A组患者行PPH联合超声刀治疗， B组患者行PPH联合消痔灵注射术治疗。比较两组临床疗效以及肛门疼痛、出血、肛缘水肿、术后6个月并发症发生情况。结果 A组治疗总有效率92.11%与B组的86.84%比较， 差异无统计学意义（P>0.05）。两组患者肛门疼痛、出血发生率比较， 差异无统计学意义（P>0.05）;A组患者肛缘水肿发生率5.26%低于B组的26.32%， 差异具有统计学意义（P<0.05）。术后6个月， 两组患者肛门坠胀感、肛门狭窄、失禁发生率比较， 差异均无统计学意义（P>0.05）;A组患者痔回缩不良发生率2.63%、皮赘残留发生率5.26%均低于B组的21.05%、28.95%， 差异均具有统计学意义（P<0.05）。结论 PPH联合超声刀与PPH联合消痔灵注射术对混合痔患者均有较好的临床治疗效果， 但是PPH联合超声刀能够降低患者术后肛缘水肿、痔回缩不良、皮赘残留等发生风险， 安全性更高。

【关键词】 混合痔;吻合器痔上黏膜环切术;超声刀;消痔灵注射术;术后并发症

DOI：10.14163/j.cnki.11-5547/r.2020.21.007

Clinical comparison of PPH combined with ultrasonic knife and Xiaozhiling injection for mixed hemorrhoids   HU Li， LI Shao-jie. Department One of Surgery， Zhongshan Southern District Hospital， Zhongshan 528455， China

【Abstract】 Objective   To investigate the difference of procedure for prolapse and hemorrhoids （PPH） combined with ultrasonic knife and Xiaozhiling injection for mixed hemorrhoids. Methods   A total of 76 patients with mixed hemorrhoids were randomly divided into group A and group B by random numerical table， with

38 cases in each group. Group A was treated by PPH combined with ultrasonic knife， and group B was treated by PPH combined with Xiaozhiling injection. The clinical efficacy， and occurrence of anal pain， bleeding， anal margin edema and complications in postoperative 6 months were compared between the two groups. Results   The total effective rate of treatment of group A was 92.11%， which had no statistically significant difference compared with that of group B 86.84% （P>0.05）. There was no statistically significant difference in incidence of anal pain and bleeding between the two groups （P>0.05）. The incidence of anal margin edema 5.26% of group A was lower than that of group B 26.32%， and the difference was statistically significant （P<0.05）. In postoperative 6 months， there was no statistically significant difference in incidence of anal distention， anal stenosis and incontinence between the two groups （P>0.05）. But the incidence of poor hemorrhoid retraction 2.63% and cutaneous tag residual 5.26% of group A were lower than those of group B 21.05% and 28.95%， and the difference was statistically significant （P<0.05）. Conclusion   PPH combined with ultrasonic knife and PPH combined with Xiaozhiling injection

has better clinical effect on patients with mixed hemorrhoids， but PPH combined with ultrasonic knife shows higher safety and can reduce the the risk of anal margin edema， poor hemorrhoid retraction and cutaneous tag residual.

【Key words】 Mixed hemorrhoids; Procedure for prolapse and hemorrhoids; Ultrasonic knife; Xiaozhiling injection; Postoperative complications

混合痔是临床发病率较高的肛肠外科疾病之一， 发病后患者内痔和外痔同时存在， 可产生肛门坠胀感、疼痛以及便血等多种临床症状， 这对患者的健康及正常生活均造成了严重的不良影响， 因此需要为其提供安全有效的治疗[1]。目前临床中针对该疾病的治疗以手术为主， PPH为一种较为成熟的手术方式， 具有显著的治疗效果， 在临床中有较多的应用。但混合痔多伴有较为严重的外痔、皮赘， 特别是血栓性外痔， 该疗法无法有效阻断重度混合痔外痔血供， 故无法在术后良好解决残留痔核或皮赘， 进而有引发术后残留皮赘、肛周瘙痒等并发症风险。为降低患者术后并发症风险， 提升临床疗效， 有研究认为可以在PPH基础上与其他疗法联合应用以保证治疗效果和安全性[2]。为此本研……