首页|超声刀分瓣留桥术联合自动弹力线套扎术和Milligan-Morgan痔切除术治疗Ⅳ度混合痔:随机对照研究

超声刀分瓣留桥术联合自动弹力线套扎术和Milligan-Morgan痔切除术治疗Ⅳ度混合痔:随机对照研究

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目的 观察超声刀分瓣留桥术联合自动弹力线套扎术治疗Ⅳ度混合痔的效果.方法 纳入2023年1-6月期间河南中医药大学第三附属医院收治的Ⅳ度混合痔患者为研究对象,采用随机数字表法将纳入患者随机均分为观察组(采用超声刀分瓣留桥术联合自动弹力线套扎术治疗)和对照组(采用Milligan-Morgan痔切除术治疗),比较2组患者的临床疗效、总住院时间、手术时间、术中出血量、住院费用、创面愈合时间、术后疼痛评分、出血评分、创缘水肿评分、术后肛门狭窄、术后尿潴留、术后肛门失禁、术后复发等情况.结果 本研究共纳入100例患者,其中观察组和对照组各50例,2组患者的性别、年龄、病程、身体质量指数及便血和肿物脱出症状比较差异均无统计学意义(P>0.05).①观察组和对照组的治疗效果均较好(100%比96.0%,经Fisher精确检验,P=0.495).②观察组的总住院时间、手术时间、创面愈合时间、术中出血量及住院费用均少于对照组(P<0.05).③观察组和对照组的术后疼痛、出血及创缘水肿评分的时间组别交互效应比较差异均无统计学意义(x2=6.668、P=0.083;x2=5.500、P=0.139;x2=6.204、P=0.102),而组别(x2=5.073、P=0.024;x2=7.107、P=0.008;x2=8.857,P=0.003)和时间(x2=188.526、P<0.001;x2=212.472、P<0.001;x2=185.110,P<0.001)的主效应比较差异有统计学意义.观察组的术后疼痛、出血及创缘水肿评分均低于对照组(x2=9.323、P=0.002;x2=18.133、P<0.001;x2=6.232、P=0.013).④观察组术后尿潴留和肛门狭窄发生率均低于对照组(P值分别为0.046和0.031),2组术后肛门失禁和术后复发发生率比较差异无统计学意义(P>0.05).结论 从本研究初步研究结果看,超声刀分瓣留桥术联合自动弹力线套扎术治疗Ⅳ度混合痔疗效较好,创面小,愈合快,安全性较高,并发症少.
Treatment of four degree mixed hemorrhoids by ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation and Milligan-Morgan hemorrhoidectomy:a randomized controlled study
Objective To observe the therapeutic efficacy of ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation for the treatment of four degree mixed hemorrhoids.Methods The patients with four degree mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2023 to June 2023 were included as the study subjects,then were randomly averagely divided into an observation group(underwent ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation)and a control group(underwent Milligan-Morgan hemorrhoidectomy)by a random number table method.The therapeutic efficacy,total hospitalization time,operation time,intraoperative blood loss,wound healing time,hospitalization costs,postoperative pain score,bleeding score,wound edema score,postoperative complications(anal stenosis,urinary retention,anal incontinence),and recurrence were compared between the two groups.Results A total of 100 patients with four degree mixed hemorrhoids treated in this hospital were included,with 50 patients in each group.There were no statistically significant differences in the general information such as the gender,age,disease course,body mass index,hematochezia,and tumor prolapse between the two groups(P>0.05).① The overall therapeutic efficacy both the observation group and the control group was well(100%versus 96.0%,Fisher exact test,P=0.495).② The observation group had less total hospitalization time,operation time,intraoperative blood loss,hospitalization costs,and wound healing time as compared with the control group(P<0.05).③ The differences in the interaction effects of the time-group for the points of postoperative pain,bleeding,and wound edema were not statistically significant(x2=6.668,P=0.083;x2=5.500,P=0.139;x2=6.204,P=0.102).However,the main effects of group(x2=5.073,P=0.024;x2=7.107,P=0.008;x2=8.857,P=0.003)and time(x2=188.526,P<0.001;x2=212.472,P<0.001;x2=185.110,P<0.001)showed statistically significant differences.The points of postoperative pain,bleeding,and wound edema in the observation group were statistically lower than thoes in the control group(x2=9.323,P=0.002;x2=18.133,P<0.001;x2=6.232,P=0.013).④ The incidences of postoperative urinary retention and anal stenosis in the observation group were lower than those in the control group(P=0.046 and 0.031,respectively),there were no statistically significant differences in the incidences of incontinence and postoperative recurrence between the two groups(P>0.05).Conclusion From the preliminary research results of this study,ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation has a better efficacy in treating four degree mixed hemorrhoids,with a smaller wound,faster healing,higher safety,and fewer complications.

four degree mixed hemorrhoidsultrasonic scalpel flap-retentiong surgeryautomatic hemorrhoid ligation

姜亚欣、杨会举、刘翔、崔世超、刘佃温

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河南中医药大学第三附属医院肛肠科(郑州 450003)

Ⅳ度混合痔 超声刀分瓣留桥术 自动弹力线套扎术

中国初级卫生保健基金会"爱医研,新无限"临床科研公益项目河南省中医药拔尖人才项目河南省科技攻关项目

YYWX202410006HN2022ZYBJ16222102310417

2024

中国普外基础与临床杂志
四川大学华西医院

中国普外基础与临床杂志

CSTPCD
影响因子:0.858
ISSN:1007-9424
年,卷(期):2024.31(7)
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