改良外剥内扎术治疗环状混合痔的临床疗效观察

Clinical observation of modified external stripping and internal ligation in treatment of annular mixed hemorrhoids

摘要:

目的 探讨外痔切剥内痔分段缝扎加皮桥整形术治疗环状混合痔的临床疗效。方法 选取2017 年 1 月—2018 年1 月在广安市人民医院就诊的112 例环状混合痔患者，采用随机数字表法分为观察组和对照组， 每组56 例。观察组采用外痔切剥内痔分段缝扎加皮桥整形术治疗，对照组采用传统外剥内扎术治疗。观察两 组手术时间、术中出血量及住院时间；术后第1 和5 天创面疼痛、出血、尿潴留及肛缘水肿评分；术后1 个 月治疗总有效率；术后1 年混合痔复发及并发症发生情况。结果 观察组手术时间长于对照组（P <0.05）， 而术中出血量及住院时间少于对照组（P <0.05）。两组术后第1 天便时出血比较，差异无统计学意义（P >0.05）； 观察组术后第5 天便时出血评分，以及术后第1 和5 天创面疼痛、肛门坠胀及肛缘水肿评分均低于对照组 （P <0.05）。观察组术后1 个月临床有效率高于对照组（P <0.05）。两组术后1 年复发率及并发症发生率比较， 差异无统计学意义（P >0.05）。结论 外痔切剥内痔分段缝扎加皮桥整形术治疗环状混合痔可以减少患者术 中及术后出血，减轻患者术后创面疼痛、尿潴留及肛缘水肿发生，适合临床推广。

Abstract:

Objective To investigate the clinical effect of external heel incision with internal malleolus suture and skin bridge plastic surgery for the treatment of annular mixed hemorrhoids. Methods During 2017.01 to 2018.01, 112 patients with annular mixed hemorrhoids who were treated in our hospital were randomly divided into observation group and control group, 56 cases in each group. The patients in the observation group were treated with external malleotomy, internal malleolus suture and skin bridge plastic surgery. For the treatment, the patients in the control group were treated with traditional external stripping and internal ligation. The surgical indexes (operative time, intraoperative blood loss and hospitalization time) of the two groups were observed. The clinical symptoms (wound pain, postoperative pain) on the 1st and 5th postoperative day. Hemorrhage, urinary retention, and anal edema were scored. The effective rate of treatment was assessed 1 month after operation, and the incidence of recurrence and complications were recorded after 1 year. Results The operation time of the observation group was higher than that of the control group (P < 0.05). The intraoperative blood loss and hospitalization time of the observation group were lower than those of the control group (P < 0.05). There was no significant difference in the bleeding between the two groups on the first day after operation (P >P 0.05); in the observation group, the bleeding score on the 5th day after operation and the wound pain, anal bulge and anal edema score on the 1st and 5th day after operation were significantly lower than those in the control group (P < 0.05); the clinical effective rate of the patients in the observation group after 1 month was significantly higher (P < 0.05); there was no significant difference in the recurrence rate and complication rate between the two groups (P > 0.05). Conclusion The treatment of annular mixed hemorrhoids with external malleolus stripping and internal malleolus suture can improve the intraoperative and postoperative hemorrhage, reduce postoperative wound pain, urinary retention and anal edema. It is suitable for clinical promotion.