吻合器痔上黏膜环形切除术对环状混合痔患者肛门功能及生活质量的影响
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摘要
目的:比较吻合器痔上黏膜环形切除术(PPH)和外剥内扎手术(MMH)治疗环状混合痔的疗效及对患者肛门功能恢复、生活质量的影响,为临床治疗环状混合痔的术式选择提供依据。方法:选取2016年8月-2018年1月我院收治的84例环状混合痔患者作为研究对象。采用随机数字表法将患者分为PPH组(n=42)和MMH组(n=42)。比较两组患者的疗效、手术及术后恢复情况。随访3个月,观察两组患者的并发症发生情况,并采用生活质量综合评定问卷(GQOL-74)评价两组患者的生活质量变化情况。术后6个月对所有患者进行直肠肛门测压,记录并比较两组测量结果。结果:PPH组患者治疗总有效率为97.62%,高于MMH组的83.33%(P<0.05)。两组患者手术时间、创面愈合时间、住院时间及恢复工作时间比较,PPH组均明显短于MMH组(P<0.05)。PPH组总并发症发生率为14.29%,低于MMH组的40.48%(P<0.05)。术后3个月,两组患者GQOL-74各维度评分均高于术前,且PPH组患者GQOL-74各维度评分均高于MMH组患者(P<0.05)。术后6个月,PPH组患者肛管静息压、肛管高压带长度、直肠肛门抑制反射阳性率均明显高于MMH组(P<0.05),但两组肛管最大收缩压和直肠静息压比较无统计学差异(P>0.05)。结论:PPH治疗环状混合痔疗效确切且兼具较高的安全性,可促进患者的术后恢复,明显改善患者肛门功能和生活质量。
Objective: To compare the effect of procedure for prolapse and hemorrhoids(PPH) and Milligan-morgan haemorrhoidectomy(MMH) on anal function and quality of life in patients with circumferential mixed hemorrhoids, so as to provide basis for the selection of surgical methods for the treatment of circumferential mixed hemorrhoids. Methods: 84 patients with circumferential mixed hemorrhoids who were treated in our hospital from January 2017 to June 2018 were selected as the research subjects. The patients were divided into PPH group(n=42)and MMH group(n=42) according to random number table method. The efficacy, operation and postoperative recovery of the two groups were compared. After 3 months of follow-up, the complications of the two groups were observed, and the quality of life comprehensive assessment questionnaire(GQOL-74) was used to evaluate the quality of life of the two groups. The anorectal manometry was performed for all patients at 6 months after operation, recorded and compared the results of measurements of two groups. Results: The total effective rate of PPH group was 97.62%, which was significantly higher than 83.33% of MMH group(P<0.05).The operation time, wound healing time, hospital stay and return to work time of PPH group were significantly shorter than those of MMH group(P<0.05). The incidence of total complications in PPH group was 14.29%, whigh was significantly lower than 40.48% in MMH group(P<0.05). At 6 months after operation, the anal canal resting pressure, the length of anal canal high pressure band and the positive rate of anorectal inhibition reflex in PPH group were significantly higher than those in MMH group(P<0.05). However, there was no significant difference between the two groups in anal systolic pressure and rectal resting pressure(P>0.05). Conclusion: PPH is effective and safe in the treatment of circumferential mixed hemorrhoids.It can promote postoperative recovery and improve anal function and quality of life in patients.
Objective: To compare the effect of procedure for prolapse and hemorrhoids(PPH) and Milligan-morgan haemorrhoidectomy(MMH) on anal function and quality of life in patients with circumferential mixed hemorrhoids, so as to provide basis for the selection of surgical methods for the treatment of circumferential mixed hemorrhoids. Methods: 84 patients with circumferential mixed hemorrhoids who were treated in our hospital from January 2017 to June 2018 were selected as the research subjects. The patients were divided into PPH group(n=42)and MMH group(n=42) according to random number table method. The efficacy, operation and postoperative recovery of the two groups were compared. After 3 months of follow-up, the complications of the two groups were observed, and the quality of life comprehensive assessment questionnaire(GQOL-74) was used to evaluate the quality of life of the two groups. The anorectal manometry was performed for all patients at 6 months after operation, recorded and compared the results of measurements of two groups. Results: The total effective rate of PPH group was 97.62%, which was significantly higher than 83.33% of MMH group(P<0.05).The operation time, wound healing time, hospital stay and return to work time of PPH group were significantly shorter than those of MMH group(P<0.05). The incidence of total complications in PPH group was 14.29%, whigh was significantly lower than 40.48% in MMH group(P<0.05). At 6 months after operation, the anal canal resting pressure, the length of anal canal high pressure band and the positive rate of anorectal inhibition reflex in PPH group were significantly higher than those in MMH group(P<0.05). However, there was no significant difference between the two groups in anal systolic pressure and rectal resting pressure(P>0.05). Conclusion: PPH is effective and safe in the treatment of circumferential mixed hemorrhoids.It can promote postoperative recovery and improve anal function and quality of life in patients.
引文
[1]Haksal MC,?iftci A,Tiryaki?,et al.Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional MilliganMorgan hemorrhoidectomy in the surgical treatment of grade 3 and 4hemorrhoids[J].Turk J Surg,2017,33(4):233-236
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[10]毛勤玲.基于GQOL-74量表的肝癌规范化癌痛护理效果评价[J].中国卫生标准管理,2017,8(14):164-166
[11]Hu WS,Lin CL.Hemorrhoid is associated with increased risk of peripheral artery occlusive disease:A nationwide cohort study[J].J Epidemiol,2017,27(12):574-577
[12]Chang SS,Sung FC,Lin CL,et al.Association between hemorrhoid and risk of coronary heart disease:A nationwide population-based cohort study[J].Medicine(Baltimore),2017,96(31):e7662
[13]Tsunoda A,Takahashi T,Kusanagi H.A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids[J].Tech Coloproctol,2017,21(8):657-665
[14]Huang HX,Yao YB,Tang Y.Application of'tying,binding and fixing operation'in surgical treatment of severe mixed hemorrhoids[J].Exp Ther Med,2016,12(2):1022-1028
[15]Xu L,Chen H,Lin G,et al.Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids:a meta-analysis of randomized control trials[J].Tech Coloproctol,2016,20(12):825-833
[16]Tanaka S,Toyonaga T,Morita Y,et al.Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids[J].World J Gastroenterol,2016,22(27):6268-6275
[17]Lu M,Yang B,Liu Y,et al.Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation[J].World JGastroenterol,2015,21(26):8178-8183
[18]詹敏,李逵,严建,等.两种微创术式治疗老年混合痔的临床疗效比较[J].现代生物医学进展,2017,17(12):2256-2259
[19]Lu M,Shi GY,Wang GQ,et al.Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids[J].World J Gastroenterol,2013,19(30):5011-5015
[20]He YH,Tang ZJ,Xu XT,et al.A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids[J].Surg Innov,2017,24(6):574-581
[21]Qin Z,Pang L,Dai W,et al.Psychodynamic and biodynamic analysis of treatment of outlet obstructive constipation(OOC)using Procedure for Prolapse and Hemorrhoids(PPH)[J].Med Hypotheses,2015,85(1):58-60
[22]沈奎,吕文辉,张承岳,等.吻合器痔上黏膜环切术与外剥内扎术治疗重度痔的疗效观察[J].安徽医学,2014,35(3):329-331
[23]Van Iersel JJ,Formijne Jonkers HA,Paulides TJC,et al.Robot-Assisted Ventral Mesh Rectopexy for Rectal Prolapse:A 5-Year Experience at a Tertiary Referral Center[J].Dis Colon Rectum,2017,60(11):1215-1223
[24]Berki C,Mohos E,Réti G,et al.Proctocolectomy with J pouch.Ileo-anal anastomosis performed with PPH stapler.Our experiences after 88 cases[J].Magy Seb,2016,69(4):159-164
[25]Trenti L,Biondo S,Galvez A,et al.Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids:postoperative morbidity and long-term outcomes[J].Tech Coloproctol,2017,21(5):337-344
[26]Yeh ML,Chung YC,Hsu LC,et al.Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain,Anxiety,and Heart Rate Variability:A Randomized-Controlled Study[J].Clin Nurs Res,2018,27(4):450-466
[27]Van Iersel JJ,Formijne Jonkers HA,Verheijen PM,et al.High-grade hemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy[J].Tech Coloproctol,2016,20(4):235-242
[28]Menconi C,Fabiani B,Giani I,et al.Persistent anal and pelvic floor pain after PPH and STARR:surgical management of the fixed scar staple line[J].Int J Colorectal Dis,2016,31(1):41-44
[29]Stewart AM,Cook MS,Dyer KY,et al.Structure-function relationship of the human external anal sphincter[J].Int Urogynecol J,2018,29(5):673-678
[30]刘扬,路明.吻合器痔上黏膜环切术与外剥内扎术治疗Ⅲ度混合痔后肛管直肠压力的对比研究[J].中国普外基础与临床杂志,2016,23(6):687-690
[2]Naderan M,Shoar S,Nazari M,et al.A Randomized Controlled Trial Comparing Laser Intra-Hemorrhoidal Coagulation and Milligan-Morgan Hemorrhoidectomy[J].J Invest Surg,2017,30(5):325-331
[3]Bakhtiar N,Moosa FA,Jaleel F,et al.Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan's hemorrhoidectomy[J].Pak J Med Sci,2016,32(3):657-661
[4]Bhatti MI,Sajid MS,Baig MK.Milligan-Morgan(Open)Versus Ferguson Haemorrhoidectomy(Closed):A Systematic Review and Meta-Analysis of Published Randomized,Controlled Trials[J].World J Surg,2016,40(6):1509-1519
[5]Ruiz-Tovar J,Duran M,Alias D,et al.Reduction of postoperative pain and improvement of patients'comfort after Milligan-Morgan hemorrhoidectomy using topical application of vitamin E ointment[J].Int JColorectal Dis,2016,31(7):1371-1372
[6]Iida Y,Saito H,Takashima Y,et al.Procedure for prolapse and hemorrhoids(PPH)with low rectal anastomosis using a PPH 03 stapler:low rate of recurrence and postoperative complications[J].Int J Colorectal Dis,2017,32(12):1687-1692
[7]Cologne KG,Linnebur M,Senagore AJ.Procedure for Prolapse and Hemorrhoids Complication Solutions:Repair of a Completely Closed Off Rectum[J].Dis Colon Rectum,2018,61(6):751
[8]沈海龙,狄长安,朱江,等.不同手术方案治疗重度环状混合痔患者的临床效果比较[J].西部医学,2016,28(7):932-934,938
[9]李阳扬,金伟森.PPH联合保留肛垫整形术治疗环状混合痔的临床疗效观察[J].中华结直肠疾病电子杂志,2016,5(2):167-170
[10]毛勤玲.基于GQOL-74量表的肝癌规范化癌痛护理效果评价[J].中国卫生标准管理,2017,8(14):164-166
[11]Hu WS,Lin CL.Hemorrhoid is associated with increased risk of peripheral artery occlusive disease:A nationwide cohort study[J].J Epidemiol,2017,27(12):574-577
[12]Chang SS,Sung FC,Lin CL,et al.Association between hemorrhoid and risk of coronary heart disease:A nationwide population-based cohort study[J].Medicine(Baltimore),2017,96(31):e7662
[13]Tsunoda A,Takahashi T,Kusanagi H.A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids[J].Tech Coloproctol,2017,21(8):657-665
[14]Huang HX,Yao YB,Tang Y.Application of'tying,binding and fixing operation'in surgical treatment of severe mixed hemorrhoids[J].Exp Ther Med,2016,12(2):1022-1028
[15]Xu L,Chen H,Lin G,et al.Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids:a meta-analysis of randomized control trials[J].Tech Coloproctol,2016,20(12):825-833
[16]Tanaka S,Toyonaga T,Morita Y,et al.Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids[J].World J Gastroenterol,2016,22(27):6268-6275
[17]Lu M,Yang B,Liu Y,et al.Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation[J].World JGastroenterol,2015,21(26):8178-8183
[18]詹敏,李逵,严建,等.两种微创术式治疗老年混合痔的临床疗效比较[J].现代生物医学进展,2017,17(12):2256-2259
[19]Lu M,Shi GY,Wang GQ,et al.Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids[J].World J Gastroenterol,2013,19(30):5011-5015
[20]He YH,Tang ZJ,Xu XT,et al.A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids[J].Surg Innov,2017,24(6):574-581
[21]Qin Z,Pang L,Dai W,et al.Psychodynamic and biodynamic analysis of treatment of outlet obstructive constipation(OOC)using Procedure for Prolapse and Hemorrhoids(PPH)[J].Med Hypotheses,2015,85(1):58-60
[22]沈奎,吕文辉,张承岳,等.吻合器痔上黏膜环切术与外剥内扎术治疗重度痔的疗效观察[J].安徽医学,2014,35(3):329-331
[23]Van Iersel JJ,Formijne Jonkers HA,Paulides TJC,et al.Robot-Assisted Ventral Mesh Rectopexy for Rectal Prolapse:A 5-Year Experience at a Tertiary Referral Center[J].Dis Colon Rectum,2017,60(11):1215-1223
[24]Berki C,Mohos E,Réti G,et al.Proctocolectomy with J pouch.Ileo-anal anastomosis performed with PPH stapler.Our experiences after 88 cases[J].Magy Seb,2016,69(4):159-164
[25]Trenti L,Biondo S,Galvez A,et al.Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids:postoperative morbidity and long-term outcomes[J].Tech Coloproctol,2017,21(5):337-344
[26]Yeh ML,Chung YC,Hsu LC,et al.Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain,Anxiety,and Heart Rate Variability:A Randomized-Controlled Study[J].Clin Nurs Res,2018,27(4):450-466
[27]Van Iersel JJ,Formijne Jonkers HA,Verheijen PM,et al.High-grade hemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy[J].Tech Coloproctol,2016,20(4):235-242
[28]Menconi C,Fabiani B,Giani I,et al.Persistent anal and pelvic floor pain after PPH and STARR:surgical management of the fixed scar staple line[J].Int J Colorectal Dis,2016,31(1):41-44
[29]Stewart AM,Cook MS,Dyer KY,et al.Structure-function relationship of the human external anal sphincter[J].Int Urogynecol J,2018,29(5):673-678
[30]刘扬,路明.吻合器痔上黏膜环切术与外剥内扎术治疗Ⅲ度混合痔后肛管直肠压力的对比研究[J].中国普外基础与临床杂志,2016,23(6):687-690