横分纵扎术治疗重度混合痔的临床评价
Clinical evaluation of transverse incision and longitudinal ligation procedure for the treat-ment of severe mixed hemorrhoids
来丽霞 1孙红 2王月 1李佳楠 1马凰富 1杨涵雯 1张学成 1王晏美1
作者信息
- 1. 中日友好医院肛肠科 北京 100029
- 2. 新疆生产建设兵团医院中医肛肠科 新疆乌鲁木齐 830002
- 折叠
摘要
目的 评价横分纵扎术(transverse incision and longitudinal ligation procedure,TILL)治疗重度混合痔的有效性和安全性,建立规范路径的高质量痔切除术式.方法 选取2020年11月至2023年4月于中日友好医院肛肠科一部住院并符合入选标准的重度混合痔患者120例,分为治疗组(采用TILL治疗,n=60)和对照组(采用Milligan-Morgan术治疗,n=60).评估两组患者术后疗效,记录创面愈合时间、创面疼痛情况(术后第1、第3、第7天评价)以及创面水肿(术后第7天评价)、肛门坠胀(术后第7天评价)情况,并记录术后3个月肛门狭窄情况及Wexner肛门失禁评分,术后6个月进行随访记录复发情况.结果 治疗组疗效优于对照组(P＜0.05),两组总有效率比较差异无统计学意义(P＞0.05).治疗组创面愈合时间较对照组短(P＜0.05).两组术后第1天创面疼痛情况比较差异无统计学意义(P＞0.05),术后第3天及第7天创面疼痛情况比较差异有统计学意义(P＜0.05).治疗组肛门坠胀情况与对照组比较差异无统计学意义(P＞0.05),创面水肿情况、肛门狭窄情况与对照组比较差异有统计学意义(P＜0.05).两组Wexner肛门失禁评分比较差异无统计学意义(P＞0.05).所有患者均在术后6个月完成随访,治疗组无复发,对照组复发1例.两组复发率比较差异无统计学意义(P＞0.05).结论 TILL通过理念及技术创新,巧妙地解决了肛门压力问题,简单易学,在促进创面愈合及减轻术后创面疼痛、创面水肿、肛门狭窄方面有一定优势,可作为规范路径的高质量痔切除术式推广使用.
Abstract
Objectives To evaluate the effectiveness and safety of the transverse incision and longitudinal ligation proce-dure(TILL)for the treatment of severe mixed hemorrhoids and to establish a high-quality hemorrhoidectomy with stan-dardized pathways.Methods A total of 120 patients with severe mixed hemorrhoids who were hospitalized in the de-partment of anorectal surgery,China-Japan Friendship Hospital from November 2020 to April 2023 and met the inclusion criteria of this study were selected and divided into a treatment group(treated with TILL,n=60)and a control group(treated with Milligan-Morgan procedure,n=60).The postoperative outcomes of the two groups were evaluated,and the wound healing time,anal pain(evaluated on the 1st,3rd,and 7th days after surgery),edema of the anal margin,anal bulge(evaluated on the 7th day after surgery),anal stenosis,and Wexner incontinence scores were recorded 3 months postoperatively.The recurrence was recorded at the 6-month follow-up.Results Treatment effectiveness in the treatment group was superior to that in the control group,with a statistically significant difference(P＜0.05).There was no statisti-cally significant difference in the overall effective rate between the two groups(P＞0.05).The wound healing time in the treatment group was shorter than that in the control group,with a statistically significant difference(P＜0.05).There was no statistically significant difference in the wound pain between the two groups on the first day after surgery(P＞0.05),but there were statistically significant differences in anal pain on the 3rd and 7th days after surgery(P＜0.05).There was no statistically significant difference in anal bulge between the treatment group and the control group(P＞0.05).However,there were statistically significant differences in edema of the anal margin and anal stenosis between the two groups(P＜0.05).There was no statistically significant difference in Wexner incontinence scores between the two groups(P＞0.05).All patients completed the 6-month follow-up,with no recurrence in the treatment group and one re-currence in the control group.There was no statistically significant difference in recurrence rates between the two groups(P＞0.05).Conclusion Through conceptual and technological innovations,TILL cleverly addresses the issue of anal pressure,is simple and easy to learn,and has certain advantages in wound healing,reducing postoperative pain,edema of the anal margin,and anal stenosis.It can be promoted and used as a high-quality hemorrhoidectomy with stan-dardized pathways.
关键词
重度混合痔/横分纵扎术/规范路径Key words
severe mixed hemorrhoids/transverse incision and longitudinal ligation procedure/standardized pathways引用本文复制引用
基金项目
中日友好医院高水平医院临床业务费专项临床研究项目(2022-NHLHCRF-LX-02-0120)
中日友好医院院级科研基金(2019-1-QN-53)
出版年
2024
国家科技期刊平台
NSTL
万方数据