龚代平

[摘要] 目的 探讨提肛运动对痔吻合器痔上黏膜环切术（PPH）术后患者肛门坠胀的改善效果。 方法 收集并筛选2013年4月～2014年6月在重庆市大足区人民医院确诊为混合痔的患者140例，将其按照随机数字表方法分为两组，观察组和对照组每组各70例，两组患者入院后第2天起给予PPH术治疗，所有操作均规范，并严格参考手术适应证，排除不适宜手术的干扰因素。其中对照组给予术后常规抗感染治疗及护理。观察组患者在上述常规干预的基础上于术后第3天给予提肛运动记录患者术后肛门坠胀消失时间，同时观察比较两组术后肛门坠胀持续时间、程度、控便能力、便感急等量化评分。 结果 两组患者术后肛门坠胀持续时间、坠胀发生程度的评分均较干预前降低，差异均有统计学意义[观察组：（2.17±0.23）比（0.05±0.00）分，（2.16±0.11）比（0.05±0.01）分；对照组：（2.19±0.07）比（1.07±0.12）分，（2.21±0.14）比（0.65±0.01）分，均 P < 0.05]，术后观察组的评分改善较对照组更为显著，差异有统计学意义（均P < 0.05）。观察组术后肛门坠胀消失时间、控便能力评分及便感急评分均较对照组下降，差异均有统计学意义[（3.50±1.14）比（5.55±1.01）分，（0.10±0.00）比（0.46±0.11）分，（0.14±0.01）比（0.37±0.02）分，均P < 0.05]。 结论 适宜的提肛运动可明显改善PPH术后肛门坠胀，减轻患者肛门坠胀程度，减少肛门坠胀时间，显著减轻PPH术后带给患者的不适感。

[关键词] 提肛运动；痔吻合器痔上黏膜环切术；肛门坠胀；改善效果

[中图分类号] R657.18 [文献标识码] A [文章编号] 1673-7210（2015）06（b）-0080-04

Improved effect of anus movement on anus bulge after procedure for prolapse and hemorrhoids

GONG Daiping

Department of Anorectal， the People's Hospital of Dazu District， Chongqing 402360， China

[Abstract] Objective To study the improved effect of anus movement on anus bulge after procedure for prolapse and hemorrhoids （PPH）. Methods 140 cases of patients with mixed hemorrhoid in Dazu District People's Hospital from April 2013 to June 2013 were collected， and they were divided into observation group and control group according to random number table method， 70 cases in each group. Patients of the two groups were given PPH surgery treatment in the second day after admission， followed all operating norms， and referenced surgical indication strictly， the interference factors of unfit for surgery were eliminated. The control group was given routine anti-infection treatment and postoperative care. Patients of the observation group was given the treatment on the basis of the conventional intervention at the 3rd day postoperative was carried anus movement. The patients' postoperative anus bulge disappear time were recorded， postoperative anus bulge duration， the degree of the anus bulge， and control ability， fecal urgency of two groups were observed， and quantitative evaluation was given at the same time. Results The scores of postoperative anus bulge duration， the degree of the anus bulge in the observation group and control group were lower compared with before， the differences were statistically significant [observation group： （2.17±0.23） vs （0.05±0.00） scores， （2.16±0.11） vs （0.05±0.01） scores； control group： （2.19±0.07） vs （1.07±0.12） scores， （2.21±0.14） vs （0.65±0.01） scores， all P < 0.05]， and the observation group were improved more significantly postoperative than the control group， the differences was statistically significant （P < 0.05）. The postoperative anus bulge disappear time ， the scores of control ability and fecal urgency in observation group were decreased than those in the control group， the differences had statistical significances [（3.50±1.14） vs （5.55±1.01） scores， （0.10±0.00） vs （0.46±0.11） scores， （0.14±0.01） vs （0.37±0.02） scores， all P < 0.05]. Conclusion The appropriate rectal carcinoma intervention is more obvious in patients with postoperative anus belly after PPH， and can effectively reduce the anus bulge， shorten the time of the anus bulge， reduce the discomfort caused by PPH.

[Key words] Anus movement； Procedure for prolapse and hemorrhoids； Anus bulge； Improved effect

痔吻合器痔上黏膜环切术（procedure for prolapse and hemorrhoids，PPH）作为目前较为新颖的一种治疗混合痔的技术，其在保证治疗效果的同时，保留了患者的肛垫、肛门等原有机体结构，整体悬吊肛垫、肛管部位的组织，上提肛垫及肛管，不仅能直接环切肛垫直肠段，与此同时使得相关结构部位自动机械吻合，避免了术后肛垫及肛管的自动脱垂或下移，较传统手术等治疗效果更为可靠且安全[1-3]。PPH患者较为常见肛门下坠、便感急等现象，甚至会导致排便暂时性失禁等较为严重的术后并发症，给患者的正常生活带来了诸多不便，降低了其生存质量。……