魏巍 魏东 李荣先 蔡建 彭昕

[摘要] 目的 探讨吻合器痔上黏膜环切钉合术（PPH）与多普勒超声引导下痔动脉结扎术（DGHAL）治疗Ⅱ～Ⅲ度痔病的临床效果。 方法 选取2010年1月～2011年12月本院收治的Ⅱ～Ⅲ度痔病患者112例，根据手术方法将患者分为PPH术组（n=58）、DGHAL术组（n=54）。比较两组患者的手术疗效、并发症及复发情况。 结果 PPH术组的术后恢复日常活动时间长于DGHAL术组，术后痛评分高于DGHAL术组，差异有统计学意义（P<0.05）。PPH术组术后远期[中位随访38个月（33～48个月）]症状评分及痔脱出复发率均低于DGHAL术组，差异有统计学意义（P<0.05）。两组患者术后8周的并发症发生率差异无统计学意义（P>0.05），术后远期，两组的所有并发症均消除。 结论 PPH术与DGHAL术均为治疗Ⅱ～Ⅲ度痔病较安全有效的手术方式，DGHAL术术后疼痛轻微，术后恢复日常活动时间短，而PPH术的远期效果可靠，痔脱出复发率低。

[关键词] 痔病；吻合器痔上黏膜环切钉合术；多普勒超声引导下痔动脉结扎术

[中图分类号] R657.1+8 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0024-04

Effect comparison of procedure for prolapse and hemorrhoids and Doppler-guided haemorrhoidal artery ligation in the treatment ofⅡ-Ⅲ degree haemorrhoids

WEI Wei1 WEI Dong2 LI Rong-xian1 CAI Jian2 PENG Xin1

1.Department of Anorectum，Central Hospital of Xinxiang City in Henan Province，Xinxiang 453000，China；2.Institute of Anal-Colorectal Surgery of PLA，the 150th Central Hospital of PLA，Luoyang 471031，China

[Abstract] Objective To discuss the clinical effect of procedure for prolapse and hemorrhoids （PPH） and Doppler-guided haemorrhoidal artery ligation （DGHAL） in the treatment of Ⅱ-Ⅲdegree haemorrhoids. Methods 112 patients with Ⅱ-Ⅲ degree haemorrhoids treated by our hospital from January 2010 and December 2011 were chosen，and they were divided into PPH group （n=58） and DGHAL group （n=54） according to operation method.The curative effect of operation，complication and recurrence between two groups was compared respectively. Results The time of recovering daily activities after operation in PPH group was longer than that of DGHAL group，pain score after operation in PPH group was higher than that of DGHAL group，and there was a statistical difference （P<0.05）.Symptom score of postoperative long-term [median follow-up of 38 months （33-48 months）] and recurrence rate of hemorrhoids prolapse in PPH group was lower than that of DGHAL group respectively， and there was a statistical difference （P<0.05）.There was no statistical difference of incidence rate of complication between two groups after 8 weeks operation （P>0.05），at postoperative long-term period， all complications were eliminated in the two groups. Conclusion PPH and DGHAL are more safe and effective method treating degree Ⅱ-Ⅲ haemorrhoids.Postoperative pain is light after DGHAL operation，and its time of recovering daily activities after operation is short，and long term effect of PPH is reliable，and its recurrence rate of hemorrhoids prolapse is low.

[Key words] Haemorrhoids；Procedure for prolapse and hemorrhoids；Doppler-guided haemorrhoidal artery ligation

痔病是最常见的肛肠疾病之一。据统计，在全球范围内，它在成人中的发病率大约为5%[1]。痔病根据病情不同而采用不同的治疗方法。长期以来外科手术治疗以外剥内扎手术（Milligan-Morgan术）作为经典术式，该术式操作简便、费用低廉，但手术创伤大，患者疼痛剧烈甚至术后影响肛门自制功能的弊端仍不容忽视。

随着科技的发展以及对痔病发病机制的深入认识，近年来出现了吻合器痔上黏膜环切钉合术（procedure for prolapse and hemorrhoids，PPH）、多普勒超声引导下痔动脉结扎术（Doppler-guided haemorrhoidal artery ligation，DGHAL）。PPH术通过悬吊直肠黏膜，恢复患病痔组织正常的解剖和生理功能。相关研究显示，PPH 术与传统痔切除手术比较痛苦小，恢复快[2-3]。同时一些报道认为，PPH术有发生严重并发症的风险[4-5]。……