摘要
[目的]探讨经肛门吻合器直肠切除术治疗Ⅱ～Ⅲ度痔病的临床疗效及复发的列线图分析.[方法]回顾性分析124例Ⅱ～Ⅲ度痔病患者的病例资料.随机数字表法将患者分为对照组和观察组,每组62例.对照组采用Milligan-Morgan手术治疗,观察组采用经肛门吻合器直肠切除术治疗.比较2组患者的围术期情况,术前、术后肛门功能评分并采用随机行走模型进行评价复发情况,并通过列线图预测模型对痔病复发的相关因素进行分析.[结果]观察组患者的手术时间、术中出血量、住院时间、术后24 h疼痛评分VAS、第1次排便疼痛持续时间、水肿时间、带血时间、术后3年复发率均明显低于对照组;治疗总有效率明显高于对照组;与术前相比,2组患者术后14 d的稀便、排气、需要衬垫、生活方式改变、Wexner总评分均明显增加,观察组患者术后14 d的肛门功能评分明显低于对照组;差异均有统计学意义(P＜0.05).遗传、便秘、辛辣饮食、长时间坐姿和手术方式是痔病复发的独立危险因素(P＜0.05).列线图预测模型预测患者痔病复发的准确度较高.[结论]经肛门吻合器直肠切除术可有效提高痔病疗效,降低术后复发率,维持肛门功能,保证肛门精细控便能力不受影响.
Abstract
[Objective]To explore the clinical efficacy and recurrence of transanal stapler rectal resection in the treatment of Ⅱ-m degree hemorrhoids.[Methods]The clinical data of 124 patients were analyzed ret-rospectively.The patients were randomly divided into control group(n=62)and observation group(n=62).The control group was treated with Milligan-Morgan operation and the observation group was treated with transanal stapler rectal resection.The perioperative conditions of the two groups were compared,the anal function scores before and after operation were evaluated by random walking model,the recurrence was e-valuated,and the related factors of hemorrhoid recurrence were analyzed by line chart prediction model.[Results]The operation time,intraoperative blood loss,hospital stay,pain score VAS 24 hours after opera-tion,duration of first defecation pain,edema time,bleeding time and recurrence rate 3 year after operation in the observation group were significantly lower than those in the control group,and the total effective rate was significantly higher than that in the control group.Compared with those before operation,the anal function scores of patients in the observation group were significantly lower than those in the control group on the 14 th day after operation,and the scores of loose stool,exhaust,need of cushion,lifestyle change and total score of Wexner in the observation group were significantly higher than those in the control group on the 14 th day after operation(P＜0.05).Heredity,constipation,spicy diet,sitting position for a long time and mode of operation were independent risk factors for recurrence of hemorrhoids(P＜0.05).The line chart prediction model has high accuracy in predicting the recurrence of hemorrhoids.[Conclusion]Transanal stapler rectal resection can effectively improve the curative effect of hemorrhoids,reduce the postoperative recurrence rate,maintain anal function,and ensure that the ability of fine anal defecation con-trol is not affected.
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