痔上黏膜套扎术加小切口外痔切除术治疗混合痔临床效果

哈晓冬 杨静 谢启明

【摘要】 目的：分析痔上黏膜套扎術（reiyun procedure for homorrhos，RPH）+小切口外痔切除术治疗混合痔临床效果。方法：选定2017年9月-2020年9月于本院住院治疗的100例混合痔患者，以单盲随机抽样法分为参照组和试验组，参照组接受传统外剥切内扎术治疗，试验组接受RPH+小切口外痔切除术治疗。对比两组临床总有效率、手术指标、肛门水肿发生率、肛门出血发生率、并发症发生率。结果：试验组显效率为96.00%，高于参照组的72.00%，差异有统计学意义（P<0.05）。试验组手术时间、住院时间、创面愈合时间均短于参照组，试验组术中出血量低于参照组，差异均有统计学意义（P<0.05）。试验组肛门水肿发生率为44.00%，低于参照组的72.00%，试验组肛门出血发生率为26.00%，低于参照组的60.00%，试验组的并发症发生率为6.00%，低于参照组的24.00%，差异均有统计学意义（P<0.05）。结论：RPH+小切口外痔切除术可有效改善混合痔患者病情，缩短治疗时间，减轻术后肛门水肿、出血程度，降低并发症发生率，值得推广。

【关键词】 痔上黏膜套扎术 小切口外痔切除术 混合痔

[Abstract] Objective： To analyze the clinical effect of reiyun procedure for homorrhos （RPH） plus small incision external hemorrhoidectomy for mixed hemorrhoids. Method： A total of 100 patients with mixed hemorrhoids hospitalized in our hospital from September 2017 to September 2020 were selected， they were divided into the reference group and the experimental group by single blind random sampling. The reference group were treated with traditional external dissection， the experimental group received RPH small incision external hemorrhoidectomy. The total clinical efficiency， operative index， the incidence of anal edema， the incidence of anal bleeding and the incidence of complications were compared between two groups. Result： The significant efficiency of the experimental group was 96.00%， which was higher than 72.00% of the reference group， the difference was statistically significant （P<0.05）. The operative time， hospital stay and wound healing time in the experimental group were shorter than those in the reference group， the amount of intraoperative blood loss in the experimental group was lower than that in the reference group， the differences were statistical significance （P<0.05）. The incidence of anal edema in the experimental group was 44.00%， which was lower than 72.00% in the control group， the incidence of anal bleeding in the experimental group was 26.00%， which was lower than 60.00% in the control group， the complication rate of the experimental group was 6.00%， which was lower than 24.00% of the control group， the differences were statistical significance （P<0.05）. Conclusion： RPH small incision external hemorrhoidectomy can effectively improve the condition of mixed hemorrhoids patients， shortening treatment time， reduce postoperative anal edema， bleeding degree， reduce the incidence of complications， its worth of promoting.

[Key words] Reiyun procedure for homorrhos Small incision external hemorrhoids resection Mixed hemorrhoids

First-authors address： The Second Peoples Hospital of Zhaoqing， Zhaoqing 526060， China

doi：10.3969/j.issn.1674-4985.2021.06.039

痔是肛周皮下血管丛血流淤滞、肛垫病理性肥大、移位而形成的团块，大部分患者均存在不同程度嵌顿、出血、坠胀、疼痛等症状[1]。据不完全统计，目前我国痔的发生率高达47%[2]。根据痔的性质，临床将其分为外痔、内痔、混合痔3种，将近60%以上的痔为混合痔[3]。传统外剥切内扎术治疗混合痔存在创面大、出血多、疼痛严重、伤口愈合速度慢、肛门容易狭窄等不足[4]。痔上黏膜套扎术（reiyun procedure for homorrhos，RPH）是近年来兴起的一种治疗混合痔的新技术，具有省时省力、操作方便、术后恢复快等优点。基于此，本研究选定2017年9月-2020年9月于本院住院治疗的100例混合痔患者，分两组给予不同治疗方案，现报道如下。

1 资料与方法

1.1 一般资料 选定2017年9月-2020年9月于本院住院治疗的100例混合痔患者。（1）纳入标準：①均经直肠指诊、肛门视诊、肛门镜等检查确诊;②年龄≥18周岁;③意识清醒、对答切题;④均经保守治疗无效。（2）排除标准：①合并急慢性感染性疾病;②合并严重营养不良、重度贫血;③处于哺乳及妊娠期;④中途从此项研究退出;⑤合并恶性肿瘤;⑥存在麻醉、手术禁忌证;⑦合并帕金森、人格分裂症;⑧过敏体质、瘢痕体质;⑨重大脏器功能障碍、衰竭;⑩合并糖尿病、血液病等疾病。……