外切与外剥内扎硬注术治疗环状嵌顿痔疗效比较
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摘要
目的:对比外切与外剥内扎硬注术治疗环状嵌顿痔的疗效和并发症。方法:回顾性分析156例环状嵌顿痔患者的临床资料,78例接受外切内扎硬注术为A组,78例接受外剥内扎硬注术为B组,对比两组治疗前后的症状评分变化情况,对比两组术口愈合时间和并发症发生情况。结果:手术治疗后1个月,A组症状评分(0.07±0.32)分,B组(0.06±0.34)分(P>0.05);A组术口愈合时间(15.61±2.01)d,B组(18.58±2.81)d(P<0.05);两组术后1周便血、肛缘赘皮、肛门失禁、肛管狭窄发生率的对比,差异没有统计学意义(P>0.05)。A组术后1周肛门疼痛发生率7.69%,排尿困难发生率3.85%,肛缘水肿发生率3.85%,均显著低于B组(P<0.05)。结论:外切内扎硬注术治疗环状嵌顿痔具有良好的临床疗效,可有效缩短术口愈合时间,减少肛门疼痛、排尿困难等术后并发症的发生率。
Objective To compare the efficacy and complications of the two therapeutics to the circular incarcerated hemorrhoids, by external excision and internal ligation and sclerotherapy, and by Milligan-Morgan operation and sclerosing agent injection.Methods Retrospective analysis on the clinical data of 156 circular incarcerated hemorrhoids patients was done, 78 cases received external excision and internal ligation and sclerotherapy as group A, and 78 cases received Milligan-Morgan operation and sclerosing agent injection as group B.The changes of symptom scores, wound healing time and incidence of complications of both groups before and af-ter treatment were observed and compared.Results One month after treatment, the symptom scores of the observation group and control group were(0.07 ± 0.32) and(0.06 ± 0.34)(P > 0.05). The wound healing time of the observation group was significantly shorter than that of the control group(15.61 ± 2.01 vs 18.58 ± 2.81, P <0.05). The differences of the incidence of complications, including hemafecia in 1 week, perianal epicanthus, copracrasia and anorectal stenosis, between the two groups were not statistically significant(P>0.05). In the observation group, the incidence rates of anal pain, dysuresia and edema of anal margin were 7.69%, 3.85% and3.85%(P < 0.05).Conclusion The combined treatment of external excision and internal ligation and sclerotherapy was effective for circular incarcerated hemorrhoids. It can effectively shorten the wound healing time andreduce the incidence of anal pain and dysuresia..
Objective To compare the efficacy and complications of the two therapeutics to the circular incarcerated hemorrhoids, by external excision and internal ligation and sclerotherapy, and by Milligan-Morgan operation and sclerosing agent injection.Methods Retrospective analysis on the clinical data of 156 circular incarcerated hemorrhoids patients was done, 78 cases received external excision and internal ligation and sclerotherapy as group A, and 78 cases received Milligan-Morgan operation and sclerosing agent injection as group B.The changes of symptom scores, wound healing time and incidence of complications of both groups before and af-ter treatment were observed and compared.Results One month after treatment, the symptom scores of the observation group and control group were(0.07 ± 0.32) and(0.06 ± 0.34)(P > 0.05). The wound healing time of the observation group was significantly shorter than that of the control group(15.61 ± 2.01 vs 18.58 ± 2.81, P <0.05). The differences of the incidence of complications, including hemafecia in 1 week, perianal epicanthus, copracrasia and anorectal stenosis, between the two groups were not statistically significant(P>0.05). In the observation group, the incidence rates of anal pain, dysuresia and edema of anal margin were 7.69%, 3.85% and3.85%(P < 0.05).Conclusion The combined treatment of external excision and internal ligation and sclerotherapy was effective for circular incarcerated hemorrhoids. It can effectively shorten the wound healing time andreduce the incidence of anal pain and dysuresia..
引文
[1]Riss S,Weiser FA,Schwameis K,et al.The prevalence of hemor-rhoids in adults[J].Int J Colorectal Dis,2012,27(2):215-220.
[2]Lohsiriwat V.Hemorrhoids:From basic pathophysiology to clinicalmanagement[J].World J Gastroenterol,2012,18(17):2009-2017.
[3]罗超兰,喻世万,周毅,等.痔切除伴肛门成形术治疗环状混合痔临床观察[J].中国中医急症,2013,22(4):617-618.
[4]美国结直肠外科医师协会标准化工作委员会,丁义江,皇甫少华,等.痔诊断和治疗指南(2010修订版)[J].中华消化外科杂志,2012,11(3):243-247.
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[6]Mounsey AL,Halladay J,Sadiq TS,et al.Hemorrhoids[J].AmFam Physician,2011,84(2):204-210.
[7]唐峻山.综合治疗嵌顿痔的临床探讨[J].中国中医急症,2011,20(11):1881-1882.
[8]谭斌,武鸿斌.外剥内扎侧切术治疗急性嵌顿痔的临床观察[J].黑龙江医学,2012,36(9):689-690.
[9]Xue,Q.-M.,He,H.-B.,Wu,J.,et al.Life threatening rectal perfora-tion after procedures for prolapse and hemorrhoids(PPH)[J].Int JColorectal Dis,2012,27(7):993-994.
[10]金杰,施捷.内痔套扎外痔剥切缝合术治疗混合痔疗效观察[J].现代中西医结合杂志,2012,21(35):3909-3911.
[11]应欣,曾莉,钱海华,等.痔手术研究进展[J].现代中西医结合杂志,2012,21(31):3529-3532.
[12]Ba Bai Ke Re MM,Huang HG,Re WN,et al.How we can im-prove patients'comfort after Milligan-Morgan open haemorrhoidec-tomy[J].World J Gastroenterol,2011,17(11):1448-1456.
[13]夏婉贤,李辉.硬化剂注射加外切内扎术治疗混合痔46例[J].中国中西医结合外科杂志,2011,17(2):231-231.
[14]张阳君.消痔灵注射术加外切内扎术治疗混合痔疗效观察[J].基层医学论坛,2012,16(7):910.
[15]郑芳,杨超,吴毅,等.肛垫悬吊固定联合消痔灵注射治疗混合痔的临床疗效[J].新医学,2011,42(12):817-819.
[16]曹传军,袁亮,李少青,等.齿线附近鞘神经的分布与混合痔术后疼痛的关系[J].岭南现代临床外科,2011,11(5):339-340.
[17]Giamundo P,Cecchetti W,Esercizio L,et al.Doppler-guided hem-orrhoidal laser procedure for the treatment of symptomatic hemor-rhoids:experimental background and short-term clinical results ofa new mini-invasive treatment[J].Surg Endosc,2011,25(5):1369-1375.
[18]罗华君,王亚波,陈华,等.痔术后排尿困难的原因分析及护理[J].中国医学创新,2011,8(32):71-72.
[19]贾立刚.痔术后肛缘水肿的原因及防治[J].河北中医,2013,35(8):1159.
[2]Lohsiriwat V.Hemorrhoids:From basic pathophysiology to clinicalmanagement[J].World J Gastroenterol,2012,18(17):2009-2017.
[3]罗超兰,喻世万,周毅,等.痔切除伴肛门成形术治疗环状混合痔临床观察[J].中国中医急症,2013,22(4):617-618.
[4]美国结直肠外科医师协会标准化工作委员会,丁义江,皇甫少华,等.痔诊断和治疗指南(2010修订版)[J].中华消化外科杂志,2012,11(3):243-247.
[5]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:285-289.
[6]Mounsey AL,Halladay J,Sadiq TS,et al.Hemorrhoids[J].AmFam Physician,2011,84(2):204-210.
[7]唐峻山.综合治疗嵌顿痔的临床探讨[J].中国中医急症,2011,20(11):1881-1882.
[8]谭斌,武鸿斌.外剥内扎侧切术治疗急性嵌顿痔的临床观察[J].黑龙江医学,2012,36(9):689-690.
[9]Xue,Q.-M.,He,H.-B.,Wu,J.,et al.Life threatening rectal perfora-tion after procedures for prolapse and hemorrhoids(PPH)[J].Int JColorectal Dis,2012,27(7):993-994.
[10]金杰,施捷.内痔套扎外痔剥切缝合术治疗混合痔疗效观察[J].现代中西医结合杂志,2012,21(35):3909-3911.
[11]应欣,曾莉,钱海华,等.痔手术研究进展[J].现代中西医结合杂志,2012,21(31):3529-3532.
[12]Ba Bai Ke Re MM,Huang HG,Re WN,et al.How we can im-prove patients'comfort after Milligan-Morgan open haemorrhoidec-tomy[J].World J Gastroenterol,2011,17(11):1448-1456.
[13]夏婉贤,李辉.硬化剂注射加外切内扎术治疗混合痔46例[J].中国中西医结合外科杂志,2011,17(2):231-231.
[14]张阳君.消痔灵注射术加外切内扎术治疗混合痔疗效观察[J].基层医学论坛,2012,16(7):910.
[15]郑芳,杨超,吴毅,等.肛垫悬吊固定联合消痔灵注射治疗混合痔的临床疗效[J].新医学,2011,42(12):817-819.
[16]曹传军,袁亮,李少青,等.齿线附近鞘神经的分布与混合痔术后疼痛的关系[J].岭南现代临床外科,2011,11(5):339-340.
[17]Giamundo P,Cecchetti W,Esercizio L,et al.Doppler-guided hem-orrhoidal laser procedure for the treatment of symptomatic hemor-rhoids:experimental background and short-term clinical results ofa new mini-invasive treatment[J].Surg Endosc,2011,25(5):1369-1375.
[18]罗华君,王亚波,陈华,等.痔术后排尿困难的原因分析及护理[J].中国医学创新,2011,8(32):71-72.
[19]贾立刚.痔术后肛缘水肿的原因及防治[J].河北中医,2013,35(8):1159.