摘要
目的观察吻合器痔上黏膜环切术(PPH)联合多普勒超声引导下痔动脉结扎术(DGHAL)治疗重度混合痔的临床效果。方法选取衡水市人民医院自2016年1月至2018年12月收治的93例重度混合痔患者为研究对象。根据手术方式不同,将仅接受PPH的41例患者纳入A组,将接受PPH+DGHAL的52例患者纳入B组。比较两组患者的围术期指标、应激指标、术后3个月的治疗效果、肛门功能指标、肛管血流动力学指标,以及术后并发症发生和随访复发情况。结果B组手术时间长于A组,差异有统计学意义(P<0.05);B组术后视觉模拟评分、术后创面愈合时间、住院时间均小于A组,差异有统计学意义(P<0.05)。两组的术中出血量比较,差异无统计学意义(P>0.05)。B组治疗有效率为96.2%(50/52),高于A组的78.0%(32/41),差异有统计学意义(P<0.05)。两组术前1 d、术后1 d的皮质醇、C反应蛋白、促肾上腺皮质激素比较,差异均无统计学意义(P>0.05);两组术后1 d皮质醇、C反应蛋白、促肾上腺皮质激素均高于术前1 d,差异有统计学意义(P<0.05)。两组术前、术后的肛管静息压、直肠静息压、肛管最大收缩压、肛管高压带长度比较,差异均无统计学意义(P>0.05);两组术后肛管静息压、直肠静息压、肛管最大收缩压、肛管高压带长度均低于术前,差异有统计学意义(P<0.05)。两组术前的收缩期峰值流速、舒张期峰值流速比较,差异均无统计学意义(P>0.05);两组术后收缩期峰值流速、舒张期峰值流速均低于术前,且B组低于A组,差异有统计学意义(P<0.05)。两组出血、肛门坠胀、尿潴留、肛缘水肿等并发症发生率比较,差异均无统计学意义(P>0.05)。A组、B组复发率比较,差异无统计学意义(P>0.05)。结论PPH联合DGHAL治疗重度混合痔安全有效,可明显减轻患者应激反应,减少混合痔血管血流。
Objective To observe the clinical effect of prolapse and hemorrhoids(PPH)combined with Doppler-guided hemorrhoidal artery ligation(DGHAL)in the treatment of severe mixed hemorrhoids.Methods A retrospective study was performed on 93 cases of patients with severe mixed hemorrhoids who were admitted from January 2016 to December 2018.According to different surgical methods,41 patients who only received PPH were included in Group A,and 52 patients who received PPH+DGHAL were included in Group B.Perioperative index,stress index,therapeutic effect 3 months after surgery,anal function index,anal hemodynamics index,postoperative complications and follow-up recurrence were compared between the two groups.Results The operation time of Group B was longer than that of Group A,and the difference was statistically significant(P<0.05).Postoperative visual simulation score,postoperative wound healing time and hospital stay in Group B were all lower than those in Group A,with statistically significant differences(P<0.05).There was no significant difference in intraoperative blood loss between Group A and Group B(P>0.05).There were no statistically significant differences in cortisol,C-reactive protein and corticotrophin in Group A and Group B on Day 1 before and day 1 after surgery(P>0.05).Cortisol,C-reactive protein and corticotrophin in the two groups were all higher on Day 1 after the operation than on Day 1 before the operation(P<0.05).The effective rate was 96.2%(50/52)in Group B,which was higher than 78.0%(32/41)in Group A(P<0.05).There was no statistically significant difference in preoperative and postoperative anorectal resting pressure,rectal resting pressure,maximum anal systolic pressure and anorectal high-pressure band length between Groups A and Group B(P>0.05).Postoperative anal resting pressure,rectal resting pressure,maximum anal systolic pressure,and anal high-pressure belt length were all lower in the two groups than before surgery(P<0.05).There was no statistically significant difference in the preoperative peak systolic and diastolic flow rates between Group A and Group B(P>0.05).The peak systolic and diastolic flow rates in the two groups were lower than those before the operation(P<0.05).There was no statistically significant difference in the incidence of bleeding,anal distention,urinary retention,and anal edema between Group A and Group B(P>0.05).There was no significant difference in the recurrence rate between Group A and Group B(P>0.05).Conclusion PPH combined with DGHAL is safe and effective in the treatment of severe mixed hemorrhoids,which can significantly reduce the stress response of patients and reduce the blood flow of mixed hemorrhoids.
作者
信学礼
宋德余
赵斌
姚洪亮
李云
孙伟
刘继攀
王成君
XIN Xue-li;SONG De-yu;ZHAO Bin;YAO Hong-liang;LI Yun;SUN Wei;LIU Ji-pan;WANG Cheng-jun(Hengshui People's Hospitcil,Hengshui 053000,China)
出处
《临床军医杂志》
CAS
2020年第4期386-389,共4页
Clinical Journal of Medical Officers
基金
河北省科技计划项目(162777272)。
