赵恩春　王斌

[摘要] 目的 探討胶圈套扎术在重度混合痔伴直肠黏膜内脱垂中的应用。 方法 选取2015年10月～2017年9月在南京中医药大学附属淮安市中医院接受治疗的重度混合痔伴直肠黏膜内脱垂患者88例，分为研究组（46例）和对照组（42例）。对照组给予外剥内扎术治疗，研究组给予胶圈套扎术治疗。比较两组临床效果、手术时间、术后排便时间、住院时间、术中出血量、疼痛评分、使用止痛剂次数，记录并比较患者出血、水肿、感染、延迟愈合、尿潴留、肛门狭窄、肛门坠胀等并发症发生情况，比较治疗后患者满意度。 结果 治疗后，研究组疗效优于对照组，差异有高度统计学意义（P < 0.01）。研究组手术时间、术后排便时间、住院时间均短于对照组，差异有高度统计学意义（P < 0.01）；研究组术中出血量低于对照组，差异有高度统计学意义（P < 0.01）；术后，两组患者疼痛评分均有降低，且研究组低于对照组，研究组使用止痛剂次数少于对照组，差异有高度统计学意义（P < 0.01）。治疗后，两组患者均出现出血、水肿、感染、延迟愈合、尿潴留、肛门狭窄、肛门坠胀等并发症，研究组并发症发生率低于对照组，差异有高度统计学意义（P < 0.01）。治疗后，研究组满意度优于对照组，差异有高度统计学意义（P < 0.01）。 结论 给予重度混合痔伴直肠黏膜内脱垂患者胶圈套扎术治疗，可有效缩短患者的住院时间，降低患者疼痛感受及降低并发生症发生率，提高患者满意度，效果显著。

[关键词] 胶圈套扎术；重度混合痔；直肠黏膜；内脱垂

[中图分类号] R675.18 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0116-04

[Abstract] Objective To investigate the application of ring ligation in severe mixed hemorrhoids with rectal mucosal prolapse. Methods From October 2015 to September 2017， in Huai′an Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine， 88 severe mixed hemorrhoids patients with internal rectal prolapse were selected， they were divided into study group （46 cases） and control group （42 cases）. The control group was given Milligan surgery； study group treated with apron ligation treatment. The clinical effect， operative time， postoperative defecation time， hospitalization time， intraoperative blood loss， pain score， analgesic use in two groups were compared， the bleeding， edema， infection， delayed healing， urinary retention， anal stenosis， anal bulge and other complications were recorded and compared， patients' satisfaction after treatment was compared. Results After treatment， the clinical effect of study group was better than control group， the difference was statistically significant （P < 0.01）. The operative time， postoperative defecation time， hospitalization time of study group were shorter than control group， the difference were statistically significant （P < 0.01）. Intraoperative blood loss of study group was less than control group， the difference was statistically significant （P < 0.01）. Postoperative pain scores of two groups reduced， and that of study group was lower than contol group， analgesic use times of study group was lower than control group， the difference were statistically significant （P < 0.01）. After treatment， patients in two groups occured bleeding， edema， infection， delayed healing， urinary retention， anal stenosis， anal bulge and other complications， the compltcation rate of study group was lower than control group， the difference was statistically significant （P < 0.01）. After treatment， satisfaction of study group was better than control group， the difference was statistically significant （P < 0.01）. Conclusion The treatment of severe mixed hemorrhoids with rectal mucosal prolapse with rubber ring ligation can effectively shorten the hospitalization time， reduce pain and incidence of disease and improve patient satisfaction.

[Key words] Ring ligation； Severe mixed hemorrhoids； Rectal mucosa； Internal prolapse

痔患者中大约有65.00%患者为混合痔，脱垂、出血、疼痛是痔的主要临床症状，严重影响患者的正常生活[1]。资料表明，临床上治疗痔的方法有许多，最为常用的方法为外剥内扎术，该治疗方法操作简单，且疗效确切，但术后患者常出现剧烈疼痛，导致创面愈合慢，延长患者住院时间，并且影响肛门精细控便，并且对患者的耐受能力要求高，年老、体弱以及合并重症的患者难以承受，因此在临床运用中受到争议[2-4]。有效降低患者术后疼痛，缩短患者住院时间，提高临床治疗效果成为临床医生亟待解决的问题[5]。本研究对南京中医药大学附属淮安市中医院（以下简称“我院”）收治重度混合痔伴直肠黏膜内脱垂并行胶……