自动痔疮套扎术结合外剥后锁边缝合治疗Ⅲ度混合痔的效果分析

Effects of Ruiyun procedure for hemorrhoids combined with interlocking suture after external dissection on grade III mixed hemorrhoids

摘要:

目的 探讨自动痔疮套扎术（RPH）结合外剥后锁边缝合治疗Ⅲ度混合痔的效果。方法 选取2020年4月—2022年6月空军特色医学中心收治的120例Ⅲ度混合痔患者，按照入院时间分为两组，对照组（入院时间2020年4月—2021年5月，58例）采取RPH术结合外痔切除，观察组（入院时间2021年6月—2022年6月，62例）采取内痔RPH术结合外剥后锁边缝合治疗，对比两组手术效果、肛门疼痛程度、排便状况、肛门动力学指标、并发症和复发情况。结果 观察组创面愈合时间、住院时间均短于对照组（P <0.05）。两组患者手术耗时比较，差异无统计学意义（P >0.05）。观察组手术前后视觉模拟评分法评分、失禁评分指数量表评分的差值均高于对照组（P <0.05）。观察组手术前后肛管最大收缩压、肛管舒张压、肛管静息压水平的差值均低于对照组（P <0.05）。观察组手术前后血清表皮生长因子、转化生长因子-β水平的差值均低于对照组（P <0.05）。两组患者并发症总发生率比较，差异无统计学意义（P >0.05）。观察组复发率低于对照组（P <0.05）。结论 Ⅲ度混合痔患者采取内痔RPH术结合外剥后锁边缝合治疗疗效显著，可明显减轻肛门疼痛、改善排便状况和肛门动力学，且复发率较低。

Abstract:

Objective To investigate the effects of Ruiyun procedure for hemorrhoids (RPH) combined with interlocking suture after external dissection on grade III mixed hemorrhoids.Methods The 120 patients with grade III mixed hemorrhoids admitted to Air Force Special Medical Center from April 2020 to June 2022 were selected and divided into two groups according to the admission time. The control group (admission time: from April 2020 to May 2021, n = 58) received RPH combined with external hemorrhoidectomy, and the observation group (admission time: from June 2020 to June 2022, n = 62) was treated with RPH for internal hemorrhoids combined with interlocking suture after external dissection. The surgical outcomes, severity of anal pain, bowel movement conditions, anal dynamic parameters, complications, and recurrence rates were compared between the two groups.Results The wound healing time and the length of hospital stay in the observation group were shorter than those in the control group (P < 0.05). There was no significant difference in the operative duration between the observation group and the control group (P > 0.05). The differences of the Visual Analogue Scale scores and the Fecal Incontinence Severity Index before and after the surgery in the observation group were higher than those in the control group (P < 0.05). The differences of the anal maximal contraction pressure, anal resting relaxation pressure and anal resting pressure before and after the surgery in the observation group were lower than those in the control group (P < 0.05). The differences of serum levels of epidermal growth factor and transforming growth factor-β before and after the surgery in the observation group were lower than those in the control group (P < 0.05). There was no significant difference in the overall complication rate between the observation group and the control group (P > 0.05). The recurrence rate in the observation group was lower than that in the control group (P < 0.05).Conclusions The treatment of grade III mixed hemorrhoids with RPH for internal hemorrhoids combined with interlocking suture after external dissection for external hemorrhoids demonstrates significant efficacy, effectively reducing anal pain, improving bowel movement conditions, enhancing anal dynamics, and lowering the recurrence rate.