摘要
目的探讨吻合器痔上黏膜环切术(PPH)联合经肛门直肠缝合悬吊术治疗重度环状脱垂痔伴慢性便秘的临床价值。方法选取2019年1月—2021年1月该院收治的121例重度环状脱垂痔伴慢性便秘患者,随机分为研究组(61例,接受PPH治疗)与对照组(60例,接受经肛门直肠下段纵行缝合悬吊术联合PPH治疗),术后随访2个月。对比两组手术前后不同时间的超氧化物歧化酶(SOD)、疼痛视觉模拟评分(VAS)、肾上腺皮质激素(ACTH),手术、卧床、住院时间及大便频率、术中失血量、术后并发症发生率。结果两组的术中失血量[(20.16±3.28)mL vs(18.94±3.79)mL]比较,差异无统计学意义(t=1.894,P>0.05),研究组的手术时间长于对照组[(50.59±5.06)min vs(30.27±5.18)min],差异有统计学意义(t=21.828,P<0.05),卧床时间[(1.79±0.33)d vs(2.02±0.35)d]、住院时间[(6.46±1.11)d vs(8.59±1.24)d]短于对照组,差异有统计学意义(t=3.720、9.959,P<0.05),大便频率[(4.05±0.68)次/周vs(2.75±0.59)次/周]高于对照组,差异有统计学意义(t=11.225,P<0.05);研究组的VAS评分高于对照组[术后3 h(4.56±0.62)分vs(4.27±0.45)分、24 h(4.79±0.55)分vs(4.38±0.47)分],差异有统计学意义(t=2.941、4.405,P<0.05),两组的VAS评分比较[术后1 h(2.79±1.20)分vs(2.63±1.12)分、2 h(3.59±0.93)分vs(3.42±1.12)分、48 h(3.50±1.08)分vs(3.59±0.94)分],差异无统计学意义(t=0.758、0.909、0.489,P>0.05);术前与术后3 d两组的ACTH[(35.25±8.36)pg/mL vs(34.54±7.69)pg/mL]、SOD[(109.25±8.36)U/mL vs(107.54±7.69)U/mL]水平比较,差异无统计学意义(P>0.05);术后2个月两组的总并发症发生率(6.56%vs 8.33%)比较,差异无统计学意义(P>0.05)。结论经肛门直肠缝合悬吊术联合PPH是一种治疗重度环状脱垂痔伴慢性便秘的可靠术式,患者术后疼痛感及应激反应轻微,术后便秘症状明显改善且并发症发生率较低。
Objective To investigate the clinical value of stapled suprahemorrhoidal circumcision(PPH)combined with transanorectal suture and suspension in the treatment of severe annular prolapsed hemorrhoids with chronic constipation.Methods A total of 121 patients with severe annular prolapsed hemorrhoids and chronic constipation in the hospital from January 2019 to January 2021 were selected.They were randomly divided into the study group(61 cases,receiving PPH treatment)and the control group(60 cases,receiving vertical suture and suspension through the lower segment of anus and rectum combined with PPH treatment),and were followed up for 2 months after operation.The superoxide dismutase(SOD),visual analog scale(VAS),adrenal cortical hormone(ACTH)before and after surgery,operation,bed rest,hospital stay and stool frequency,intraoperative blood loss,incidence of postoperative complications were compared between the two groups.Results There was no statistically significant difference in intraoperative blood loss between the two groups[(20.16±3.28)mL vs(18.94±3.79)mL](t=1.894,P>0.05).The operation time of the study group was longer than the control group[(50.59±5.06)min vs(30.27±5.18)min],and the difference was statistically significant(t=21.828,P<0.05);bed time[(1.79±0.33)d vs(2.02±0.35)d],hospital stay[(6.46±1.11)d vs(8.59±1.24)d]were shorter than the control group,the difference was statistically significant(t=3.720,9.959,P<0.05),and the stool frequency was higher than the control group[(4.05±0.68)times/week vs(2.75±0.59)times/week],the difference was statistically significant(t=11.225,P<0.05);after surgery the VAS score of the group was higher than that of the control group[3 h(4.56±0.62)points vs(4.27±0.45)points and 24 h(4.79±0.55)points vs(4.38±0.47)points],and the difference was statistically significant(t=2.941,4.405,P<0.05);there was no statistically significant difference in the VAS score between the two groups[1 h after operation(2.79±1.20)points vs(2.63±1.12)points,2 h(3.59±0.93)points vs(3.42�
作者
李超
LI Chao(Department of General Surgery,Third People's Hospital of Xiantao City,Xiantao,Hubei Province,433000 China)
出处
《世界复合医学》
2022年第2期35-39,共5页
World Journal of Complex Medicine
关键词
经肛门直肠缝合悬吊术
重度环状脱垂痔
便秘
吻合器痔上黏膜环切术
Transanorectal suture suspension
Severe annular prolapse hemorrhoids
Constipation
Stapled hemorrhoids mucosal circumcision
