王峰 孙欣鑫 孙黎明

[摘要] 目的 探討吻合器痔上黏膜环切术与外剥内扎术对重度痔疮的治疗效果。 方法 前瞻性研究2019年3月至2020年3月在我科手术治疗的106例重度痔疮患者，采用随机数字表法分为两组，每组各53例。对照组使用外剥内扎术，观察组使用吻合器痔上黏膜环切术，比较两组的各项围术期指标、并发症发生率、血清疼痛应激指标、肛肠动力学指标。 结果 观察组手术时间、术中出血量、术后3 d VAS疼痛评分、止痛药使用次数、创面愈合时间、住院时间均明显少于对照组（P<0.05）;观察组肛缘水肿、肛门狭窄、肛门失禁、尿潴留等并发症发生率明显低于对照组（P<0.05）;观察组术后3 d的SP、NPY、IL-6、NGF、PGE2水平明显低于对照组（P<0.05）;观察组术后1个月的MSP、MTV明显高于对照组，而RRP、AIRT明显低于对照组（P<0.05）。 结论 吻合器痔上黏膜环切术对重度痔疮的治疗效果更好，创伤小，术后疼痛应激反应轻，对肛肠动力影响小，恢复快，并发症发生率低，具有积极的临床意义。

[关键词] 重度痔疮;吻合器痔上黏膜环切术;外剥内扎术;治疗效果

[中图分类号] R657.1          [文献标识码] B          [文章编号] 1673-9701（2021）06-0075-04

Therapeutic effect of procedure for prolapse and hemorrhoids and Milligan-Morgan hemorrhoidectomy on severe hemorrhoids

WANG Feng   SUN Xinxin   SUN Liming

Department of Gastrointestinal Surgery & Thyroid and Breast Surgery， Laiyang Central Hospital of Yantai City in Shandong Province， Yantai   265200， China

[Abstract] Objective To explore the therapeutic effect of procedure for prolapse and hemorrhoids （PPH） and Milligan-Morgan hemorrhoidectomy on severe hemorrhoids. Methods A prospective study of 106 patients with severe hemorrhoids treated in our department from March 2019 to March 2020 was conducted. They were randomLy divided into the control group and the observation groups，each group has 53 cases. The control group was treated with Milligan-Morgan hemorrhoidectomy， while the observation group was treated with PPH. The perioperative index， complication rate， serum pain stress index and anorectal dynamics index of the two groups were compared. Results The operation time， blood loss during operation， VAS pain score at 3 days after operation， analgesic use times， wound healing time and hospitalization time in the observation group were significantly less than those in the control group（P<0.05）. The incidence of complications such as anal edge edema， anal stenosis， anal incontinence and urinary retention in the observation group was significantly lower than that in the control group（P<0.05）. The levels of SP， NPY， IL-6， NGF and PGE2 in the observation group were significantly lower than those in the control group at 3 days after operation（P<0.05）. MSP and MTV in the observation group were significantly higher than those in the control group one month after operation， while RRP and AIRT were significantly lower than those in the control group（P<0.05）. Conclusion PPH has better curative effect on severe hemorrhoids， with less trauma， less postoperative pain and stress reaction， less influence on anorectal dynamics， quicker recovery and lower complication rate， which has positive clinical significance.

2.4 两组术前术后肛肠动力学指标比较

观察组术后1个月的MSP、MTV明显高于对照组，而RRP、AIRT明显低于对照组（P<0.05）。见表4。

3 讨论

痔疮是最为常见的肛肠慢性疾病，病程呈慢性发展，若发展至重度痔疮，可引发反复便血、贫血、嵌顿坏死等症状，甚至造成大出血，明显影响患者健康[8]。手术是彻底根治重度痔疮的主要方法，外剥内扎术和PPH均是常用术式。外剥内扎术虽能彻底切除病灶，但存在术后并发症发生率高、后遗症多、复发率高等问题，且术后疼痛反应强烈，创面愈合较慢[9]。因此，外剥内扎术并非重度痔疮最佳手术选择。

PPH是新型痔疮术式，通过环形切除直肠黏膜及黏膜下组织达到根治效果，所有操作基本上在齿状线上进行，切除两端的直肠黏膜也在齿状线上吻合，既不破坏肛垫组织，又能上提肛垫，并切断痔血供，切除残留外痔，促使术后痔块逐步萎缩，达到了较高的根治率[10]。……