丁超+王琛

[摘要]痔是临床上的常见病和多发病，关于痔病的治疗，现代概念认为80%以上的痔疮以保守治疗为主，仅少数在保守治疗无效或Ⅲ、Ⅳ度内痔病理解剖和生理功能不可逆时才考虑手术治疗，而手术的目的首要的是消除病灶、解除症状的同时尽最大可能保留正常组织。笔者通过检索和复习近年来国内外的相关文献，就混合痔手术治疗的最新认识及主要治疗手段研究进展综述如下，以期对临床混合痔的手术治疗提供一定的借鉴和参考意义。

[关键词]混合痔；手术治疗；研究进展；能量设备

[中图分类号] R657.1+8 [文献标识码] A [文章编号] 1674-4721（2017）05（b）-0012-03

Study process of surgical treatment of mixed hemorrhoids

DING Chao WANG Chen

Department of Anorectum，Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 230032，China

[Abstract]Hemorrhoid is a common and prevalent disease in clinic.As for the treatment of Hemorrhoids，more than 80% of hemorrhoids just need conservative treatment in the modern idea.Only a few cases invalid by the conservative treatment，or Ⅲ，Ⅳ degree of hemorrhoids which having irreversible pathological anatomy and physiological function，then surgical operation is considered to use.The primary aim of the operation is eliminating lesions，relieving symptoms and reserving normal mucosa as much as possible.By searching and review the related literature at home and abroad in recent years，this article reviews some progresses in the surgical treatment of hemorrhoids in order to provide some reference and reference significance.

[Key words]Mixed hemorrhoids；Surgical treatment；Study process；Energy device

隨着对混合痔发病机制的不断认识，手术治疗的目的已从过去力争将所有痔组织彻底切除，转变为尽可能保留肛垫组织的完整性的同时纠正肛垫的肥大和移位。手术的适应证包括非手术治疗和侵入性治疗方法（硬化及注射、红外线凝固、橡胶圈套扎、冷冻治疗等）失败者、Ⅲ～Ⅳ度患者、有较大外痔及具有共存病手术指征的患者，如肛裂或肛瘘。临床中面临不同的病例，如何选择一种具有个体化的手术方法，在提高疗效的同时，最大限度地减轻患者术后痛苦，减少并发症，缩短住院时间，同时兼顾社会经济学效益是临床医师一直关注的课题[1]。本文重点对近年来临床上和文献报道的混合痔手术治疗的研究进展作综述如下。

1传统及其改良术式

1.1外剥内扎术

即Millian-Morgan术，是现临床最常用的结扎切除术之一，被称作痔手术的“金标准”[2]。……