[1]倪航航,梁志宏,刘书强,等.对Ⅲ度痔两种手术方式治疗效果的评价[J].医学信息,2018,31(11):107-109,112.[doi:10.3969/j.issn.1006-1959.2018.11.033]
　NI Hang-hang,LIANG Zhi-hong,LIU Shu-qiang,et al.Evaluation of the Effect of Two Kinds of Surgical Treatment for Ⅲ Degree Hemorrhoids[J].Journal of Medical Information,2018,31(11):107-109,112.[doi:10.3969/j.issn.1006-1959.2018.11.033]
点击复制

对Ⅲ度痔两种手术方式治疗效果的评价()

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
31卷
期数:
2018年11期
页码:
107-109,112
栏目:
临床研究
出版日期:
2018-06-01

文章信息/Info

Title:
Evaluation of the Effect of Two Kinds of Surgical Treatment for Ⅲ Degree Hemorrhoids
文章编号:
1006-1959（2018）11-0107-04
作者:
倪航航; 梁志宏; 刘书强; 华 伟; 江雪峰; 宋林泉
南方医科大学附属小榄医院普外一区，广东 中山 528415
Author(s):
NI Hang-hang; LIANG Zhi-hong; LIU Shu-qiang; HUA Wei; JIANG Xue-feng; SONG Lin-quan
Puwai I District,Xiaolan Hospital Affiliated to Southern Medical University,Zhongshan 528415,Guangdong,China
关键词:
吻合器痔上黏膜环切术; 外剥内扎术; 复发; 倾向得分匹配法; Ⅲ度痔; 疼痛
Keywords:
Key words：Stapler hemorrhoid mucosa circumcision; Milligan-morgan hemorrhoidectomy; Recurrence; Propensity score matching; Ⅲ degree hemorrhoids; Pain
分类号:
R657.18
DOI:
10.3969/j.issn.1006-1959.2018.11.033
文献标志码:
A
摘要:
目的 比较吻合器痔上黏膜环切术与传统外剥内扎切除术两种手术方式治疗Ⅲ度痔的疗效。方法 回顾性收集2014年6月~2015年6月在南方医科大学附属小榄医院行痔疮手术的128例患者临床资料，按手术方法分为两组，吻合器痔上黏膜环切术组78例，传统外剥内扎切除术组50例，采用倾向得分匹配法均衡组间混杂因素影响，对匹配后的两组患者进行术后复发率及并发症的分析。结果 经倾向得分匹配法后，共计43对患者匹配成功，吻合器痔上黏膜环切术组的术后2年复发率46.51%，高于传统外剥内扎切除术组18.61%，差异有统计学意义（P＜0.05）；吻合器痔上黏膜环切术组（23.25%）比传统外剥内扎术组（4.65%）有更多患者有里急后重感（P＜0.05）；术后出血、尿潴留、尿失禁、肛门狭窄、肛裂、大便失禁、直肠阴道瘘方面，差异无统计学意义（P＞0.05）；传统外剥内扎切除术组患者在术后第1天、第3天、术后2周疼痛程度均比吻合器痔上黏膜环切术组强烈，差异有统计学意义（P＜0.05）；吻合器痔上黏膜环切术组的总住院费用，高于传统外剥内扎切除术组，差异有统计学意义（P<0.05）。结论 吻合器痔上黏膜环切术术后短期2周内疼痛更轻微，但术后里急后重感发生率和术后2年复发率更高。
Abstract:
Abstract：Objective To compare the curative effects of two surgical methods, namely stapler hemorrhoid mucosa circumcision and conventional milligan-morgan hemorrhoidectomy,for the treatment of third degree hemorrhoids.Methods The clinical data of 128 patients undergoing hemorrhoids surgery from June 2014 to June 2015 in Xiaolan Hospital,Southern Medical University were retrospectively collected.The patients were divided into two groups according to the surgical method.78 patients were treated with stapled hemorrhoids.conventional milligan-morgan hemorrhoidectomy group,50 patients were treated with propensity score matching to balance the influence of confounding factors between the two groups,and the postoperative recurrence rate and complications of the matched patients were analyzed.Results After propensity score matching method, a total of 43 patients were successfully matched.The postoperative 2-year recurrence rate was 46.51%,which was higher than that of conventional milligan-morgan hemorrhoidectomy group 18.61%,the difference was statistically significant(P<0.05);The patients with hemorrhoids and mucous membrane circumferential resection(23.25%)had more acute urgency than the conventional milligan-morgan hemorrhoidectomy group(4.65%)(P< 0.05).There was no significant difference in postoperative bleeding,urinary retention,urinary incontinence,anal stenosis,anal fissure, fecal incontinence,and recto-vaginal fistula(P>0.05);In the conventional milligan-morgan hemorrhoidectomy group,the pain degree on the first day,the third day,and the second postoperative week were all stronger than those in the stapler supracondylar mucosal loop group,and the difference was statistically significant(P<0.05).The total hospitalization cost of the stapled device for prolapse and hemorrhoids was higher than that of the conventional milligan-morgan hemorrhoidectomy group,the difference was statistically significant (P<0.05).Conclusion The stapling procedure for supracondylar mucosal loop surgery is mild in the short term after 2 weeks,but the incidence of postoperative acute heaviness and postoperative 2 years recurrence rate is higher.

参考文献/References:

[1]Riss S,Weiser F A,Schwameis K,et al.The prevalence of hemorrhoids in adults[J].Int J Colorectal Dis,2012,27(2):215-220. [2]Classic articles in colonic and rectal surgery.Edward Thomas Campbell Milligan 1886-1972.Surgical anatomy of the anal canal,and the operative treatment of haemorrhoids[J].Dis Colon Rectum,1985,28(8):620-628. [3]Racalbuto A,Aliotta I,Corsaro G,et al.Hemorrhoidal stapler prolapsectomy vs.Milligan-Morgan hemorrhoidectomy:a long-term randomized trial[J].Int J Colorectal Dis,2004,19(3):239-244. [4]Mehigan B J,Monson J R,Hartley J E.Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial[J].Lancet,2000,355(9206):782-785. [5]Jayaraman S,Colquhoun P H,Malthaner R A.Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery[J].Dis Colon Rectum,2007,50(9):1297-1305. [6]Kim J S,Vashist Y K,Thieltges S,et al.Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy in circumferential third-degree hemorrhoids:long-term results of a randomized controlled trial[J].J Gastrointest Surg,2013,17(7):1292-1298. [7]倪航航,周霞,梁志宏,赵象文.膈下引流管对腹腔镜胆囊切除术后72h内肩痛的影响[J].中国微创外科杂志,2016,16(7):628-631. [8]黄河,王艳杰.PPH与外剥内扎术治疗混合痔的效果对比[J].齐齐哈尔医学院学报,2017,38(21):2520-2522. [9]吴诗安,李延俭,袁远程.传统痔切除术与PPH术治疗痔疮的临床疗效观察[J].临床普外科电子杂志,2017,5(3):37-39. [10]Stuto A,Favero A,Cerullo G,et al.Double stapled haemorrhoidopexy for haemorrhoidal prolapse:indications,feasibility and safety[J].Colorectal Dis,2012,14(7):e386-e389. [11]Watson A J,Hudson J,Wood J,et al.Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease(eTHoS):a pragmatic,multicentre,randomised controlled trial[J].Lancet,2016,388(10058):2375-2385. [12]Shen J,Luo X,Zhou X,et al.Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption: a prospective study[J].J Pain Res,2017,10:197-201. [13]Lyons N,Cornille J B,Pathak S,et al.Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief[J].Colorectal Dis,2017,19(9):803-811. [14]Garg P,Lakhtaria P,Song J,et al.Proctitis due to retained staples after stapler hemorrhoidopexy and a review of literature[J]. Int J Colorectal Dis,2010,25(2):289-290. [15]Ambe P C,Wassenberg D R.Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure:a retrospective observational cohort study in 129 patients[J].Patient Saf Surg,2015,9:36. [16]Infantino A,Altomare D F,Bottini C,et al.Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids[J].Colorectal Dis,2012,14(2):205-211. [17]Jacobs D O.Hemorrhoids: what are the options in 2018[J].Curr Opin Gastroenterol,2017.

相似文献/References:

[1]胡智亮,黄晓东,李春伟,等.改良半闭合痔切除术治疗混合痔的效果[J].医学信息,2020,33(14):95.[doi:10.3969/j.issn.1006-1959.2020.14.027]
　HU Zhi-liang,HUANG Xiao-dong,LI Chun-wei,et al.Effect of Modified Semi-closed Hemorrhoidectomy on Mixed Hemorrhoids[J].Journal of Medical Information,2020,33(11):95.[doi:10.3969/j.issn.1006-1959.2020.14.027]
[2]吴 优,王 丽,刘春强.桃红四物汤熏洗坐浴治疗混合痔术后患者的效果及对创面水肿和疼痛的影响[J].医学信息,2021,34(11):167.[doi:10.3969/j.issn.1006-1959.2021.11.047]
　WU You,WANG Li,LIU Chun-qiang.Effect of Fumigation and Sitting Bath Treatment with Taohong Siwu Decoction on Postoperative Edema and Pain of Mixed Hemorrhoids[J].Journal of Medical Information,2021,34(11):167.[doi:10.3969/j.issn.1006-1959.2021.11.047]
[3]侯松涛,张俊仲.自动弹力线痔套扎术联合外痔切除术治疗混合痔的效果[J].医学信息,2021,34(20):129.[doi:10.3969/j.issn.1006-1959.2021.20.033]
　HOU Song-tao,ZHANG Jun-zhong.Effect of Automatic Elastic Thread Hemorrhoid Ligation Combined with External Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids[J].Journal of Medical Information,2021,34(11):129.[doi:10.3969/j.issn.1006-1959.2021.20.033]
[4]耿绪旺.吻合器痔上黏膜环切术联合悬吊固定术治疗重度痔并内脱垂的近远期疗效及并发症观察[J].医学信息,2023,36(16):129.[doi:10.3969/j.issn.1006-1959.2023.16.025]
　GENG Xu-wang.Observation on Short-term and Long-term Efficacy and Complications of Procedure for Prolapse and Hemorrhoids Combined with Suspension Fixation in the Treatment of Severe Hemorrhoids with Internal Prolapse[J].Journal of Medical Information,2023,36(11):129.[doi:10.3969/j.issn.1006-1959.2023.16.025]
[5]熊 虹,曾慧琳.规范化心理护理对混合痔外剥内扎术患者围手术期不良心理和术后疼痛的影响[J].医学信息,2025,38(11):169.[doi:10.3969/j.issn.1006-1959.2025.11.036]
　XIONG Hong,ZENG Huilin.Effect of Standardized Psychological Nursing on Perioperative Adverse Psychological and Postoperative Pain in Patients with Mixed Hemorrhoid External Stripping and Internal Ligation[J].Journal of Medical Information,2025,38(11):169.[doi:10.3969/j.issn.1006-1959.2025.11.036]
[6]吴在富,沈词伟.RPH联合外剥内扎术治疗混合痔的临床效果及对患者术后24 h疼痛程度的影响[J].医学信息,2026,39(01):154.[doi:10.3969/j.issn.1006-1959.2026.01.029]
　WU Zaifu,SHEN Ciwei.Clinical Effect of RPH Combined with Milligan-Morgan Hemorrhoidectomy in the Treatmentof Mixed Hemorrhoids and its Effect on Pain Degree at 24 h After Operation[J].Journal of Medical Information,2026,39(11):154.[doi:10.3969/j.issn.1006-1959.2026.01.029]

更新日期/Last Update: 2018-06-01