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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 184 -187. doi: 10.3877/cma.j.issn.1674-0793.2018.03.008

所属专题： 文献；

论著

吻合器痔上黏膜环形切除术与传统外剥内扎术治疗混合痔术后长期随访对比
张卫平1, 吴国忠1,†(), 张超杰1, 莫晓东1   
  1. 1. 214100　无锡，解放军101医院（无锡太湖医院）普外科
  • 收稿日期:2017-11-01 出版日期:2018-06-01
  • 通信作者: 吴国忠
  • 基金资助:
    无锡市卫生局科研项目(MS201405)

Comparison of procedure for prolapse and hemorrhoids and Milligan Morgan therapy for mixed hemorrhoids after long-term follow-up

Weiping Zhang1, Guozhong Wu1,†(), Chaojie Zhang1, Xiaodong Mo1   

  1. 1. Department of General Surgery, the 101st Hospital of PLA, Wuxi 214000, China
  • Received:2017-11-01 Published:2018-06-01
  • Corresponding author: Guozhong Wu
  • About author:
    Corresponding author: Wu Guozhong, Email:
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引用本文：

张卫平, 吴国忠, 张超杰, 莫晓东. 吻合器痔上黏膜环形切除术与传统外剥内扎术治疗混合痔术后长期随访对比[J]. 中华普通外科学文献(电子版), 2018, 12(03): 184-187.

Weiping Zhang, Guozhong Wu, Chaojie Zhang, Xiaodong Mo. Comparison of procedure for prolapse and hemorrhoids and Milligan Morgan therapy for mixed hemorrhoids after long-term follow-up[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(03): 184-187.

目的

对比混合痔外剥内扎术（M-M）和吻合器痔上黏膜环切术（PPH）两种手术的近远期并发症，评估PPH疗效。

方法

选择2008年1月至2012年2月解放军101医院符合要求的混合痔患者198例，根据手术方式分为PPH组87例，M-M组111例，对两组患者的手术学指标、近远期疗效以及随访情况进行比较。

结果

198例患者均治愈出院，PPH组的术后VAS疼痛评分优势明显（t=2.292，P=0.035），但较M-M组更易发生尿潴留（Z=-2.219，P=0.026），治疗费用也显著高于M-M组（t=7.490，P=0.000）。随访率100.0%，随访时间50~90个月，平均随访时间（74±19.1）个月。PPH组复发率为32.2%（28/87），显著高于M-M组的27.0%（30/111）（χ2=0.626，P=0.037）；PPH组和M-M组总体并发症（28.7% vs 31.5%）、再手术率（11.5% vs 7.2%）、总体满意度比较，差异均无统计学意义（χ2=0.181、1.081，P=0.052、0.298；Z=-0.248，P=0.804）。

结论

PPH术远期复发率较高，是对传统混合痔手术方法的一种补充，应严格把握适应证，慎重选择。

关键词: 痔, 吻合器痔上黏膜环切术, 混合痔外剥内扎术
Objective

To evaluate the effect of procedure for prolapse and hemorrhoids (PPH) for mixed hemorrhoids, by comparison short- and long-term complications of Milligan Morgan (M-M) and PPH.

Methods

Between January 2008 and February 2012, one hundred and ninety-eight cases with mixed hemorrhoids were collected from the 101st Hospital of PLA. According to the mode of operation, 87 cases were divided into Group PPH, and 111 cases in Group M-M. The surgical index, short- and long-term effect, and follow-up between the two groups were compared.

Results

All the 198 patients were cured and discharged. Compared with Group M-M, the VAS pain score in Group PPH had obvious advantage (t=2.292, P=0.035); however, urine retention was more likely to occur (Z=-2.219, P=0.026), with higher cost (t=7.490, P=0.000). The follow-up rate was 100.0%, and the follow-up time was 50-90 (74±19.1) months. The recurrence rate of Group PPH was 32.2% (28/87), which was significantly higher than that in Group M-M (27.0%, 30/111) (χ2=0.626, P=0.037). There were no significant differences in the total complication (28.7% vs 31.5%), reoperation rate (11.5% vs 7.2%) and total satisfaction between Group PPH and Group M-M.

Conclusions

The long-term recurrence rate of PPH is high. As supplement to the traditional method for mixed hemorrhoid operation, it should be strictly grasped and chosen carefully.

Key words: Hemorrhoids, Procedure for prolapse and hemorrhoids, Milligan Morgan
表1 两组混合痔患者基本资料比较
组别 例数 男/女(例) 年龄(岁, ±s) Ⅱ/Ⅲ/Ⅳ度(例) 病程（月）
PPH组 87 41/46 21~71(51.3±20.0) 24/32/31 4~120（54.5±33.8）
M-M组 111 54/57 22~79(50.3±18.3) 33/39/39 3~180（55.6±40.1）
统计值 χ2=0.045 t=0.366 χ2=0.118 t=0.293
P值 0.831 >0.05 0.943 >0.05
表2 两组混合痔患者住院期间近期指标
组别 例数 手术时间（min） 尿潴留(分) 术后VAS疼痛评分 术后住院天数（d） 住院费用(元) 肛门功能(分)
PPH组 87 35±12.70 1(1,2) 7.88±1.70 4.05±0.91 9 442±440 0(0,0)
M-M组 111 40±16.40 1(0,1) 9.93±2.20 4.00±1.02 7 394±415 0(0,0)
检验值 t =0.292a Z=-2.219 b t =2.292 a t =0.079 a t =7.490 a Z=-0.248 b
P值 0.443 0.026 0.035 0.074 0.000 0.804
表3 两组混合痔患者术后复发及并发症发生情况[例(%)，χ2检验]
组别 例数 复发 并发症 再手术
出血 脱垂 皮赘 肛门疼痛 排便困难 肛门狭窄 排便不尽
PPH组 87 18(20.7) 22(25.3) 26(29.9) 10(11.5) 9(10.3) 2(2.3) 15(17.2) 10(11.5)
M-M组 111 16(14.4) 15(13.5) 19(17.1) 14(12.6) 13(11.7) 3(2.7) 20(18.0) 8(7.2)
χ2值 1.356 4.453 4.521 0.057 0.092 0.032 0.028 1.081
P值 0.245 0.035 0.033 0.811 0.783 0.832 0.887 0.298
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