两种不同牵引法对吻合器痔上黏膜环切术治疗Ⅲ～Ⅳ度内痔的疗效对比研究
|
摘要
目的:对比两种不同牵引法对吻合器痔上黏膜环切术(PPH)治疗Ⅲ～Ⅳ度内痔的效果,探索一种PPH治疗内痔的最佳牵引方法。方法:选取2016年3月-2018年3月韶关市第一人民医院肛肠外科收治的80例Ⅲ～Ⅳ度内痔患者,按照随机数字表法平均分为二点牵引法组和四点牵引法组,各40例。比较两组患者的手术时间、术中出血量、黏膜宽度、术后住院时间、术后出血量、创面愈合时间,术后3、7、30 d的疼痛程度评分,术前1 d和术后3、7、30 d症状评分。所有患者术后1、3个月均进行门诊随访,比较两组的并发症发生率、肛垫上移率和总有效率。结果:二点牵引法组手术时间、术中出血量均少于四点牵引法组,黏膜宽度长于四点牵引法组,差异均有统计学意义(P<0.05)。术后3 d,二点牵引法组的症状评分低于四点牵引法组,差异有统计学意义(P<0.05)。术后30 d,二点牵引法组的疼痛评分低于四点牵引法组,差异有统计学意义(P<0.05)。二点牵引法组的术后并发症发生率低于四点牵引法组,差异有统计学意义(x~2=9.04,P<0.05);二点牵引法组的肛垫上移率为100%(40/40),四点法牵引组肛垫上移率为90%(36/40),两组比较差异无统计学意义(x~2=2.37,P>0.05)。术后随访1、3个月,两组的总有效率均为100%,比较差异均无统计学意义(P>0.05);术后随访1个月时,二点牵引法组治愈及有效例数与四点牵引法组比较,差异有统计学意义(x~2=5.70,P<0.05);术后随访3个月时,两组的治愈及有效例数比较,差异无统计学意义(x~2=0.14,P>0.05)。结论:二点牵引法在保证PPH切除痔上黏膜宽度的同时,相较于四点牵引法能更好地降低术中出血量、术后症状评分,减轻患者术后长期疼痛,减少手术时间和并发症的发生,值得在PPH治疗中推广应用。
Objective:To compare the effects of two different traction method to procedure for prolapse and internal hemorrhoids treating hemorrhoid(PPH)of Ⅲ-Ⅳ degrees and explore the best method of traction.Method:Eighty patients with Ⅲ-Ⅳ degree internal hemorrhoids admitted to the Department of Anorectal Surgery,First People's Hospital of Shaoguan City from March 2016 to March 2018 were selected.According to the random number table,they were divided into two-point traction method group and four-point traction method group,40 cases in each group.The operation time,intraoperative blood loss,mucosal width,postoperative hospital stay,postoperative bleeding volume,wound healing time,pain scores at 3,7 and 30 days after surgery,symptom scores 1 d before surgery and 3,7 and 30 d after surgery between the two groups were compared.All patients were followed up 1 and 3 months after the operation,the incidence of complications,the rate of anal pad displacement and the total effective rate were compared between the two groups.Result:The operative time and intraoperative blood loss of the two-point traction group were less than those of the four-point traction group,and the mucosal width was longer than that of the four-point traction group,with statistically significant differences(P<0.05).3 days after surgery,the symptom score of the two-point traction group was lower than that of the four-point traction group,the difference was statistically significant(P<0.05).30 days after surgery,the pain score of the twopoint traction group was lower than that of the four-point traction group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the two-point traction group was lower than that in the four-point traction group,the difference was statistically significant( x~2=9.04,P<0.05).The anal pad displacement rate of the two-point traction group was 100%(40/40),and that of the four-point traction group was90%(36/40),there was no significant difference between the two groups( x~2=2.37,P>0.05).After 1 and 3 months of postoperative follow-up,the total effective rate of the two groups were all 100%,the difference was not statistically significant(P>0.05);at 1 month of postoperative follow-up,the number of cured and effective cases in the two-point traction group were significantly higher than those in the four-point traction group,the difference was statistically significant( x~2=5.70,P<0.05);at 3 months postoperative follow-up,there were no significant differences in the number of cured cases and effective cases between the two groups( x~2=0.14,P>0.05).Conclusion:The two-point traction method can better reduce the intraoperative blood loss and postoperative symptom score,reduce the long-term pain after surgery,reduce the operation time and concurrency,while ensuring the width of the mucosa on the PPH,the occurrence of the disease is worthy of promotion and application in the treatment of PPH.
Objective:To compare the effects of two different traction method to procedure for prolapse and internal hemorrhoids treating hemorrhoid(PPH)of Ⅲ-Ⅳ degrees and explore the best method of traction.Method:Eighty patients with Ⅲ-Ⅳ degree internal hemorrhoids admitted to the Department of Anorectal Surgery,First People's Hospital of Shaoguan City from March 2016 to March 2018 were selected.According to the random number table,they were divided into two-point traction method group and four-point traction method group,40 cases in each group.The operation time,intraoperative blood loss,mucosal width,postoperative hospital stay,postoperative bleeding volume,wound healing time,pain scores at 3,7 and 30 days after surgery,symptom scores 1 d before surgery and 3,7 and 30 d after surgery between the two groups were compared.All patients were followed up 1 and 3 months after the operation,the incidence of complications,the rate of anal pad displacement and the total effective rate were compared between the two groups.Result:The operative time and intraoperative blood loss of the two-point traction group were less than those of the four-point traction group,and the mucosal width was longer than that of the four-point traction group,with statistically significant differences(P<0.05).3 days after surgery,the symptom score of the two-point traction group was lower than that of the four-point traction group,the difference was statistically significant(P<0.05).30 days after surgery,the pain score of the twopoint traction group was lower than that of the four-point traction group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the two-point traction group was lower than that in the four-point traction group,the difference was statistically significant( x~2=9.04,P<0.05).The anal pad displacement rate of the two-point traction group was 100%(40/40),and that of the four-point traction group was90%(36/40),there was no significant difference between the two groups( x~2=2.37,P>0.05).After 1 and 3 months of postoperative follow-up,the total effective rate of the two groups were all 100%,the difference was not statistically significant(P>0.05);at 1 month of postoperative follow-up,the number of cured and effective cases in the two-point traction group were significantly higher than those in the four-point traction group,the difference was statistically significant( x~2=5.70,P<0.05);at 3 months postoperative follow-up,there were no significant differences in the number of cured cases and effective cases between the two groups( x~2=0.14,P>0.05).Conclusion:The two-point traction method can better reduce the intraoperative blood loss and postoperative symptom score,reduce the long-term pain after surgery,reduce the operation time and concurrency,while ensuring the width of the mucosa on the PPH,the occurrence of the disease is worthy of promotion and application in the treatment of PPH.
引文
[1]黄闻东,曾军,牛晓华,等.吻合器痔上黏膜环切术联合外剥内扎术治疗中重度痔疮的疗效分析[J].临床医学工程,2018,25(6):717-718.
[2]黄龙虎,杨钟惠.吻合器痔上黏膜环切术和外剥内扎术治疗重度痔疮的临床疗效比较[J].临床合理用药杂志,2018,11(4):141-143.
[3]冯丽英.吻合器痔上黏膜环切术治疗重度混合痔的效果分析[J].中国临床新医学,2016,9(5):428-430.
[4]赵卫红,冯运章,吕保芳,等.改良吻合器痔上黏膜环切术联合直肠黏膜塔状缝合术在直肠前突中的应用[J/OL].中华普通外科学文献(电子版),2018,12(3):180-183.
[5]陈杏仪,廖明,梁家基,等.吻合器痔环切术联合痔核缝扎术治疗出血性重度痔的临床效果[J].中国当代医药,2018,25(14):51-53.
[6]连文,王成兴,梁文龙,等.不同牵引方法对吻合器痔上黏膜环切术治疗重度痔病疗效的影响[J].中国医师进修杂志,2014,36(32):36-38.
[7]中华医学会外科学分会结直肠肛门外科学组,中华中医药学会肛肠病专业委员会,中国中西医结合学会结直肠肛门病专业委员会.痔临床诊治指南(2006版)[J].中华胃肠外科杂志,2006,9(5):461-463.
[8]高万露,汪小海.视觉模拟疼痛评分研究的进展[J].医学研究杂志,2013,42(12):144-146.
[9]国家中医药管理局.中医肛肠科病证诊断疗效标准[M].南京:南京大学出版社,1996:33.
[10]罗显民.吻合器痔上黏膜环切术治疗重度痔疮患者的临床观察[J].深圳中西医结合杂志,2016,26(18):83-85.
[11]何健忠,王爱亮,刘春辉.桃红四物汤加减熏洗治疗混合痔术后肛周疼痛水肿临床观察[J].现代中西医结合杂志,2018,27(19):2111-2113.
[12] Alexia B T,Pierre B,Annick Z,et al.Lessons from the first70 patients operated by doppler-guided haemorrhoidal artery ligation with mucopexy in a French team specialising in surgical proctology[J].Journal of Coloproctology,2018,38(2):111-116.
[13]石琳.PPH治疗急性嵌顿性环状混合痔临床疗效分析[J].中国卫生产业,2014,11(26):167-168.
[14]余传学,韦俊武.PPH术后吻合口狭窄的原因分析及防治策略[J].中国肛肠病杂志,2017,37(9):66-67.
[15]曹登义,王彬,李培生,等.吻合器痔上粘膜环切术相关并发症的诊治分析[J].淮海医药,2017,35(6):705-708.
[16]廖健南,邱磊,谢沛标,等.PPH治疗内痔发生术后大出血的危险因素分析及对策[J].结直肠肛门外科,2014,20(1):26-29.
[17]刘国庆,刘飞.选择性痔上粘膜切除术与吻合器环形痔切除术治疗Ⅲ~Ⅳ度内痔的临床对比分析[J].农垦医学,2016,38(3):236-238.
[18]陈富军,牟奇容,贺平.环状混合痔的手术治疗现状[J].结直肠肛门外科,2013,19(2):130-132.
[19]黎威.探讨吻合器痔上黏膜环切术与传统痔疮切除术治疗痔疮的临床疗效[J].中国实用医药,2017,12(18):32-33.
[20]王家泰.PPH手术治疗临床分析[J].医学信息,2017,30(3):282-283.
[2]黄龙虎,杨钟惠.吻合器痔上黏膜环切术和外剥内扎术治疗重度痔疮的临床疗效比较[J].临床合理用药杂志,2018,11(4):141-143.
[3]冯丽英.吻合器痔上黏膜环切术治疗重度混合痔的效果分析[J].中国临床新医学,2016,9(5):428-430.
[4]赵卫红,冯运章,吕保芳,等.改良吻合器痔上黏膜环切术联合直肠黏膜塔状缝合术在直肠前突中的应用[J/OL].中华普通外科学文献(电子版),2018,12(3):180-183.
[5]陈杏仪,廖明,梁家基,等.吻合器痔环切术联合痔核缝扎术治疗出血性重度痔的临床效果[J].中国当代医药,2018,25(14):51-53.
[6]连文,王成兴,梁文龙,等.不同牵引方法对吻合器痔上黏膜环切术治疗重度痔病疗效的影响[J].中国医师进修杂志,2014,36(32):36-38.
[7]中华医学会外科学分会结直肠肛门外科学组,中华中医药学会肛肠病专业委员会,中国中西医结合学会结直肠肛门病专业委员会.痔临床诊治指南(2006版)[J].中华胃肠外科杂志,2006,9(5):461-463.
[8]高万露,汪小海.视觉模拟疼痛评分研究的进展[J].医学研究杂志,2013,42(12):144-146.
[9]国家中医药管理局.中医肛肠科病证诊断疗效标准[M].南京:南京大学出版社,1996:33.
[10]罗显民.吻合器痔上黏膜环切术治疗重度痔疮患者的临床观察[J].深圳中西医结合杂志,2016,26(18):83-85.
[11]何健忠,王爱亮,刘春辉.桃红四物汤加减熏洗治疗混合痔术后肛周疼痛水肿临床观察[J].现代中西医结合杂志,2018,27(19):2111-2113.
[12] Alexia B T,Pierre B,Annick Z,et al.Lessons from the first70 patients operated by doppler-guided haemorrhoidal artery ligation with mucopexy in a French team specialising in surgical proctology[J].Journal of Coloproctology,2018,38(2):111-116.
[13]石琳.PPH治疗急性嵌顿性环状混合痔临床疗效分析[J].中国卫生产业,2014,11(26):167-168.
[14]余传学,韦俊武.PPH术后吻合口狭窄的原因分析及防治策略[J].中国肛肠病杂志,2017,37(9):66-67.
[15]曹登义,王彬,李培生,等.吻合器痔上粘膜环切术相关并发症的诊治分析[J].淮海医药,2017,35(6):705-708.
[16]廖健南,邱磊,谢沛标,等.PPH治疗内痔发生术后大出血的危险因素分析及对策[J].结直肠肛门外科,2014,20(1):26-29.
[17]刘国庆,刘飞.选择性痔上粘膜切除术与吻合器环形痔切除术治疗Ⅲ~Ⅳ度内痔的临床对比分析[J].农垦医学,2016,38(3):236-238.
[18]陈富军,牟奇容,贺平.环状混合痔的手术治疗现状[J].结直肠肛门外科,2013,19(2):130-132.
[19]黎威.探讨吻合器痔上黏膜环切术与传统痔疮切除术治疗痔疮的临床疗效[J].中国实用医药,2017,12(18):32-33.
[20]王家泰.PPH手术治疗临床分析[J].医学信息,2017,30(3):282-283.