黄国锋+邱光明+周明珠

[摘要]目的 對比吻合器痔上黏膜环切术（PPH）联合外痔剥切术和传统外剥内扎术治疗重度环状混合痔的临床效果。方法 将我院2014年4月～2016年4月收治的62例重度环状混合痔患者按照不同的治疗方法分为观察组和对照组各31例，对照组患者采用传统分段外剥内扎术治疗，观察组患者采用PPH联合外痔剥切术治疗。比较两组患者临床病理生理参数、远期治疗效果及术后并发症发生情况。结果 观察组患者手术时间、术中出血量、术后疼痛时间、术后36 h麻醉药物使用次数及住院时间均较对照组患者显著减少（P<0.01）；两组患者术后VAS疼痛评分均较前1 d显著降低（P<0.01），且观察组患者术后第1～3天 VAS疼痛评分显著低于同时段对照组（P<0.01）；观察组患者治疗总有效率为93.5%，显著高于对照组的71.0%（P<0.05）；观察组患者术后并发症发生率为12.9%，显著低于对照组的38.7%（P<0.05）。结论 PPH联合外痔剥切术治疗重度环状混合痔与传统分段外剥内扎术相比具有创伤小、恢复快、痛苦小、术后并发症少的优点。

[关键词]吻合器痔上黏膜环切术；外痔切剥术；外剥内扎术；环状混合痔

[中图分类号] R657.1+8 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0054-04

[Abstract]Objective To compare the effect of procedure for prolapse and haemorrhoids（PPH） combined with external hemorrhoids cutting-stripping surgery and traditional Milligan-Morgan surgery in the treatment of circumferential mixed hemorrhoids.Methods A total of 62 patients with circumferential mixed hemorrhoids who were treated in our hospital from April 2014 to April 2016 were enrolled in and divided into observation group and control group according to different treatment methods，with 31 patients in each group.Patients in the observation group were treated with PPH combined with external hemorrhoids cutting-stripping surgery，while patients in the control group were treated with traditional Milligan-Morgan surgery.The clinical pathophysiological parameters，effect and postoperative complication rate of two groups were compared.Results Operation time，intraoperative blood loss，postoperative pain time；using times of postoperative 36 h anesthesia drug and hospital stay time in the observation group was significantly less than that in the control group （P<0.01）.VAS score of after surgery in both groups was significantly lower than that on the day before（P<0.01） and VAS score of in the observation group was significantly lower than that in the control group at simultaneous stage （P<0.01）.Total effective rate of the observation group was 93.5%，which was significantly higher than 71.0% of the control group；while postoperative complication rate of the observation group was 12.9%，which was significantly lower than 38.7% of the control group （P<0.05）.Conclusion PPH combined with external hemorrhoids cutting-stripping surgery has the advantages of less trauma，sooner reconery，less pain and postoperative complication compared with Milligan-Morgan surgery in the treatment of circumferential mixed hemorrhoids.

[Key word]PPH；External hemorrhoids cutting-stripping surgery；Milligan-Morgan surgery；Circumferential mixed hemorrhoids

环状混合痔是痔病发展的最终阶段，其发病机制尚不明确[1]。随着人们工作、生活压力的加剧和饮食习惯的改变，其发病率逐年升高，对患者生活质量造成严重影响。目前临床对于重度环状混合痔首选手术治疗，传统术式多为外剥内扎术，但其手术创伤大、术后疼痛明显、恢复时间长[2]，而理想中的术式应在消除病变的同时尽可能使肛门少受影响[3]。近年来吻合器痔上黏膜环切术（procedure for prolapse and haemorrhoids，PPH）已广泛应用于直肠脱垂和复杂性内痔的治疗，具有创伤小、恢复快、疼痛轻的优点，但不适用于外痔[4]。本研究旨在探讨将PPH联合外痔剥切术治疗重度环状混合痔的临床效果，现报道如下。

1资料与方法

1.1一般资料

将2014年4月～2016年4月我院肛肠科收治的62例重度环状混合痔患者按照不同的治疗方法分为观察组和对照组各31例。……