RPH、外剥内扎术联合肛垫悬吊及皮桥整形术治疗中老年女性脱垂性环状痔的临床观察

Clinical observation of modified Milligan-Morgan hemorrhoidectomy and RPH in the treatment of prolapsed circumferential hemorrhoids in middle-aged and elderly women

摘要:

目的 探讨以自动痔疮套扎术（RPH）、外剥内扎术（M-M）为基础的肛垫悬吊及皮桥整形术治疗中老年女性脱垂性环状痔的临床疗效。方法 选取2018年1月—2019年1月于遂宁市中心医院就诊的124例中老年女性脱垂性环状痔患者，随机分为对照组和观察组，每组62例。对照组患者采用RPH、M-M治疗，观察组患者采用RPH、M-M联合肛垫悬吊、皮桥整形术治疗。观察两组患者手术时间、术中出血量及住院时间等手术相关指标；比较两组患者术后第4天便时出血、创面疼痛、肛缘水肿评分等临床症状；比较两组患者术后1个月治疗有效率；比较两组患者术后3个月肛缘皮赘形成、肛门直肠狭窄、肛门形态。结果 观察组手术时间较对照组长（P <0.05）。观察组创面疼痛、便时出血、肛门坠胀、肛缘水肿评分较对照组低（P <0.05）。观察组治疗总有效率较对照组高（P <0.05）。观察组肛缘皮赘形成、肛门形态评分较对照组低（P <0.05）。结论 RPH、M-M联合肛垫悬吊、皮桥整形术可显著减轻老年女性脱垂性环状痔患者黏膜及外痔脱垂症状，降低患者便时出血、创面疼痛及肛缘水肿程度，减少术后肛缘皮赘形成，适合临床推广。

Abstract:

Objective To investigate the clinical efficacy of modified Milligan-Morgan (M-M) hemorrhoidectomy and Ruiyun procedure for hemorrhoids (RPH) in the treatment of prolapsed circumferential hemorrhoids in middle-aged and elderly women.Methods A total of 124 middle-aged and elderly female patients with prolapsed circumferential hemorrhoids who were treated in our hospital from January 2018 to January 2019 were randomly divided into the control group and the observation group, with 62 cases in each group. The patients in the control group were treated with RPH and M-M hemorrhoidectomy, while the patients in the observation group were treated with RPH and M-M hemorrhoidectomy combined with anal cushion suspension and skin bridge plastic surgery. The duration of operation, intraoperative blood loss, and length of hospital stay; hemorrhage during a bowel movement, wound pain, and perianal edema 4 days after the surgery; the effective rate of the treatment 1 month after the surgery; the perianal skin tags, anorectal stenosis and anal morphology 3 months after the surgery were observed and compared between the two groups.Results The duration of operation of the observation group was higher than that of the control group (P < 0.05). There was no significant difference in the length of hospital stay and intraoperative blood loss between the two groups (P > 0.05). The scores of wound pain, hemorrhage during a bowel movement, and perianal edema 4 days after the surgery were lower in the observation group than those in the control group (P < 0.05). The overall effective rate of the observation group was higher than that of the control group at 1 month after operation (P < 0.05). There was no significant difference in anorectal stenosis score between the two groups 3 months after the surgery (P > 0.05), while scores of the perianal skin tags and anal morphology 3 months after the surgery in the observation group were lower than those in the control group (P < 0.05).Conclusions RPH and M-M hemorrhoidectomy combined with anal cushion suspension and skin bridge plastic surgery can significantly improve the symptoms of external hemorrhoids and mucosal prolapse in middle-aged and elderly female patients with prolapsed circumferential hemorrhoids, and reduce postoperative hemorrhage during a bowel movement, wound pain, perianal edema and perianal skin tags. Thus, the modified M-M hemorrhoidectomy and RPH are worthy of further application in clinical practice.