陆淼炯　褚卫建　夏瑜++郑易++黄海

[摘要] 目的 比较内痔结扎外痔切除一期缝合术和传统Milligan-Morgan术的疗效及术后疼痛、水肿、出血等情况。 方法 将2015年1月～2016年12月就诊于我院肛肠外科的100例混合痔患者招募入组。随机将患者分为两组，试验组50例采用内痔结扎外痔切除一期缝合术，对照组50例采用传统Milligan-Morgan术。观察两组切口愈合时间、术后疼痛、水肿、出血等情况。 结果 试验组与对照组治愈率比较无显著差异（96% vs 94%，P>0.05）。试验组术后24 h（3.95±1.24 vs 5.85±1.56，P<0.05）、第一次排便时（5.85±1.66 vs 7.75±1.68，P<0.05）及术后第7天（2.45±1.09 vs 4.35±1.26，P<0.05）疼痛评分均显著低于对照组。试验组创面愈合时间（11.95±1.96 vs 17.85±2.35，P<0.05）、术后出血积分（1.05±0.31 vs 1.87±0.65，P<0.05）及术后水肿积分（0.58±0.22 vs 1.24±0.26，P<0.05）均显著低于对照组。 结论 与传统Milligan-Morgan术相比，内痔结扎外痔切除一期缝合术疗效肯定，愈合时间短，疼痛轻，术后并发症少。

[关键词] 混合痔；内痔结扎；外痔切除一期缝合术；传统Milligan-Morgan术

[中圖分类号] R657.18 [文献标识码] B [文章编号] 1673-9701（2017）26-0051-04

Clinical observation on 50 cases of internal hemorrhoid ligation external hemorrhoids resection primary suture in the treatment of mixed hemorrhoids

LU Miaojiong1 CHU Weijian1 XIA Yu1 ZHENG Yi1 HUANG Hai2

1.Department of Anorectal Surgery， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou 310007， China； 2. Department of No.1 Surgery， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou 310007， China

[Abstract] Objective To compare the efficacy and postoperative pain， edema and hemorrhage between internal hemorrhoid ligation external hemorrhoids resection primary suture and traditional Milligan-Morgan technique. Methods A total of 100 patients with mixed hemorrhoids in Department of Anorectal Surgery of our hospital from January 2015 to December 2016 were enrolled. These patients were randomly divided into two groups. 50 patients in the experimental group were treated with internal hemorrhoid ligation and external hemorrhoids resection primary suture. 50 patients in the control group were treated with traditional Milligan-Morgan technique. The wound healing time， postoperative pain， edema and bleeding of the two groups were observed. Results There was no significant difference in the cure rate between the experimental group and the control group（96% vs 94%， P>0.05）. The pain score of the experimental group was significantly lower than that in the control group at 24 hours after surgery（3.95±1.24 vs 5.85±1.56，P<0.05）， at the first time of defecation （5.85±1.66 vs 7.75±1.68，P<0.05）， on the 7th day after surgery （2.45±1.09 vs 4.35±1.26，P<0.05）. Similarly， the wound healing time， postoperative bleeding score and postoperative edema score in the experimental group were significantly lower than those in the control group （11.95±1.96 vs 17.85±2.35， P<0.05）， （1.05±0.31 vs 1.87±0.65， P<0.05）， （0.58±0.22 vs 1.24±0.26， P<0.05），respectively. Conclusion Compared with the traditional Milligan-Morgan technique， the treatment of internal hemorrhoid ligation external hemorrhoids resection primary suture has positive effect， with short healing time， mild pain and few postoperative complications.endprint

[Key words] Mixed hemorrhoids； Internal hemorrhoid ligation； External hemorrhoids resection primary suture； Traditional Milligan-Morgan

Milligan-Morgan术式是治疗混合痔的传统术式[1]，在临床上也是使用最广和最受欢迎的术式[2，3]，但其有创面愈合时间长、疼痛出血等并发症明显等缺点[4]，而痔切除缝合术因为存在术后伤口感染等并发症的制约，国内外相关的报道和研究较少，缺乏与其他手术疗效及并发症方面的系统比较。因此，本研究将2015年1月～2016年12月就诊于我院肛肠外科的100例混合痔患者随机分为试验组和对照组，试验组50例采用内痔结扎外痔切除一期缝合术，对照组50例采用传统Milligan-Morgan术，比较两组疗效及术后疼痛、水肿、出血等情况。

1 资料与方法

1.1 临床资料

纳入标准：①年龄在18～70岁之间。②符合非环状混合痔的诊断标准。③持续或间断经保守治疗无效。④签署知情同意书，并且可以完成随访者。⑤同意手术且无明显手术禁忌证。排除伴有炎症性肠病、肛瘘、肛裂及肛周脓肿等其他疾病的患者。根据纳入、排除标准选择100例Ⅱ～Ⅳ期非环状混合痔患者为研究对象，其中男38例，女62例，年龄19～70岁，平均48.5岁，病程2个月～35年。按照……