改良半闭合痔切除术治疗混合痔的效果

胡智亮　黄晓东　李春伟　毛龙飞

摘要：目的  探讨改良半闭合痔切除术治疗混合痔的效果。方法  选取我院2016年1月～2019年1月收治的160例混合痔患者作为研究对象，随机分为观察组和对照组，每组80例。对照组采用外剥内扎术治疗，观察组采用改良半闭合痔切除術治疗，比较两组临床疗效、手术指标、术后不同时间点疼痛积分、手术前后肛管收缩压、肛管静息压及并发症发生情况。结果  两组临床总有效率，手术时间，术后肛管收缩压、肛管静息压，肛周感染、肛门坠胀、尿潴留发生率比较，差异无统计学意义（P>0.05）;观察组手术中出血量、住院时间、伤口愈合时间优于对照组（P<0.05）;观察组术后24 h、第3天及第7天疼痛评分均低于对照组（P<0.05）;术后肛门狭窄及精细控便障碍发生率为0、2.50%，低于对照组的6.25%、11.25%（P<0.05）。结论  改良半闭合痔切除术可减少患者手术中出血量、缩短住院时间及伤口愈合时间，降低患者疼痛和肛门狭窄及精细控便障碍发生率。

关键词：混合痔;外剥内扎术;改良半闭合痔切除术

中图分类号：R657.1+8                               文献标识码：A                               DOI：10.3969/j.issn.1006-1959.2020.14.027

文章编号：1006-1959（2020）14-0095-03

Effect of Modified Semi-closed Hemorrhoidectomy on Mixed Hemorrhoids

HU Zhi-liang，HUANG Xiao-dong，LI Chun-wei，MAO Long-fei

（Department of Anorectal，Wuxi Traditional Chinese Medicine Hospital，Wuxi 214071，Jiangsu，China）

Abstract：Objective  To explore the effect of modified semi-closed hemorrhoidectomy on mixed hemorrhoids.Methods  A total of 160 patients with mixed hemorrhoids admitted in our hospital from January 2016 to January 2019 were selected as the research object， and randomly divided into observation group and control group， 80 cases in each group. The control group was treated with external stripping and internal ligation， and the observation group was treated with modified semi-closed hemorrhoidectomy.The clinical efficacy， surgical indicators （operation time， hospitalization time， wound healing time and bleeding volume）， pain scores at different time points after operation， anal canal systolic pressure， anal canal resting pressure and complications before and after surgery were compared between the two groups.Results  The total clinical effectiveness， operation time， postoperative anal systolic pressure， anal canal resting pressure， perianal infection， anal swell， and urinary retention were not significantly different between the two groups （P>0.05）; observation The bleeding volume， hospitalization time， and wound healing time of the group were better than the control group（P<0.05）; the pain scores of the observation group at 24 h， 3 d， and 7 d were lower than the control group（P<0.05）; the incidence of postoperative anal stenosis and fine bowel control disorders was 0， 2.50%， lower than the control group of 6.25%， 11.25%（P<0.05）.Conclusion  Modified semi-closed hemorrhoidectomy can reduce the amount of bleeding during surgery， shorten the hospital stay and wound healing time， and reduce the incidence of pain and anal stenosis and fine stool control disorders.

Key words：Mixed hemorrhoids;External stripping and internal ligation;Modified semi-closed hemorrhoidectomy

混合痔（mixed hemorrhoids）是肛腸外科常见病、多发病，据报道[1]，我国城市居民肛肠病发病率为51.14%，其中以痔、肛瘘、肛裂、肛门湿疹、肛管脱垂这5种疾病最常见。混合痔发病时常伴有反复便血、痔核脱出等症状[2]。目前，对于混合痔的治疗以手术治疗为主，药物治疗为辅，手术主要以混合痔外剥内扎术为主，然而由于术后切口容易暴露在潮湿及相对污染的环境中，容易刺激肛门内括约肌，导致局部肌肉痉挛，并引发疼痛、便秘、出血、水肿、坠胀、尿潴留、创面不易愈合等一系列并发症，不仅给患者带来痛苦，且影响伤口愈合[3]。因此对传统术式进行改进，寻找微创、价格低廉、术后恢复快捷的术式成为迫切需要解决的问题。我院根据肛管的生理病理特征，结合Ferguson闭合式痔切除术，对该术式进行了改进，提出了改良半闭合痔切除术治疗混合痔，基于此，本研究主要探讨改良半闭合痔切除术治疗混合痔的效果，现报道如下。