对Ⅲ度痔两种手术方式治疗效果的评价(1)
摘 要：目的 比較吻合器痔上黏膜环切术与传统外剥内扎切除术两种手术方式治疗Ⅲ度痔的疗效。方法 回顾性收集2014年6月～2015年6月在南方医科大学附属小榄医院行痔疮手术的128例患者临床资料，按手术方法分为两组，吻合器痔上黏膜环切术组78例，传统外剥内扎切除术组50例，采用倾向得分匹配法均衡组间混杂因素影响，对匹配后的两组患者进行术后复发率及并发症的分析。结果 经倾向得分匹配法后，共计43对患者匹配成功，吻合器痔上黏膜环切术组的术后2年复发率46.51%，高于传统外剥内扎切除术组18.61%，差异有统计学意义(P<0.05)；吻合器痔上黏膜环切术组(23.25%)比传统外剥内扎术组(4.65%)有更多患者有里急后重感(P<0.05)；术后出血、尿潴留、尿失禁、肛门狭窄、肛裂、大便失禁、直肠阴道瘘方面，差异无统计学意义(P>0.05)；传统外剥内扎切除术组患者在术后第1天、第3天、术后2周疼痛程度均比吻合器痔上黏膜环切术组强烈，差异有统计学意义(P<0.05)；吻合器痔上黏膜环切术组的总住院费用，高于传统外剥内扎切除术组，差异有统计学意义(P<0.05)。结论 吻合器痔上黏膜环切术术后短期2周内疼痛更轻微，但术后里急后重感发生率和术后2年复发率更高。
, 百拇医药
关键词：吻合器痔上黏膜环切术；外剥内扎术；复发；倾向得分匹配法；Ⅲ度痔；疼痛
中图分类号：R657.18 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.11.033
文章编号：1006-1959(2018)11-0107-04
Evaluation of the Effect of Two Kinds of Surgical Treatment for Ⅲ Degree Hemorrhoids
NI Hang-hang，LIANG Zhi-hong，LIU Shu-qiang，HUA Wei，JIANG Xue-feng，SONG Lin-quan
(Puwai I District，Xiaolan Hospital Affiliated to Southern Medical University，Zhongshan 528415，Guangdong，China)
, 百拇医药
Abstract：Objective To compare the curative effects of two surgical methods， namely stapler hemorrhoid mucosa circumcision and conventional milligan-morgan hemorrhoidectomy，for the treatment of third degree hemorrhoids.Methods The clinical data of 128 patients undergoing hemorrhoids surgery from June 2014 to June 2015 in Xiaolan Hospital，Southern Medical University were retrospectively collected.The patients were divided into two groups according to the surgical method.78 patients were treated with stapled hemorrhoids.conventional milligan-morgan hemorrhoidectomy group，50 patients were treated with propensity score matching to balance the influence of confounding factors between the two groups，and the postoperative recurrence rate and complications of the matched patients were analyzed.Results After propensity score matching method， a total of 43 patients were successfully matched.The postoperative 2-year recurrence rate was 46.51%，which was higher than that of conventional milligan-morgan hemorrhoidectomy group 18.61%，the difference was statistically significant(P<0.05)；The patients with hemorrhoids and mucous membrane circumferential resection(23.25%)had more acute urgency than the conventional milligan-morgan hemorrhoidectomy group(4.65%)(P< 0.05).There was no significant difference in postoperative bleeding，urinary retention，urinary incontinence，anal stenosis，anal fissure， fecal incontinence，and recto-vaginal fistula(P>0.05)；In the conventional milligan-morgan hemorrhoidectomy group，the pain degree on the first day，the third day，and the second postoperative week were all stronger than those in the stapler supracondylar mucosal loop group，and the difference was statistically significant(P<0.05).The total hospitalization cost of the stapled device for prolapse and hemorrhoids was higher than that of the conventional milligan-morgan hemorrhoidectomy group，the difference was statistically significant (P<0.05).Conclusion The stapling procedure for supracondylar mucosal loop surgery is mild in the short term after 2 weeks，but the incidence of postoperative acute heaviness and postoperative 2 years recurrence rate is higher., 百拇医药(倪航航 梁志宏 刘书强 华伟 江雪峰 宋林泉)
, 百拇医药
关键词：吻合器痔上黏膜环切术；外剥内扎术；复发；倾向得分匹配法；Ⅲ度痔；疼痛
中图分类号：R657.18 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.11.033
文章编号：1006-1959(2018)11-0107-04
Evaluation of the Effect of Two Kinds of Surgical Treatment for Ⅲ Degree Hemorrhoids
NI Hang-hang，LIANG Zhi-hong，LIU Shu-qiang，HUA Wei，JIANG Xue-feng，SONG Lin-quan
(Puwai I District，Xiaolan Hospital Affiliated to Southern Medical University，Zhongshan 528415，Guangdong，China)
, 百拇医药
Abstract：Objective To compare the curative effects of two surgical methods， namely stapler hemorrhoid mucosa circumcision and conventional milligan-morgan hemorrhoidectomy，for the treatment of third degree hemorrhoids.Methods The clinical data of 128 patients undergoing hemorrhoids surgery from June 2014 to June 2015 in Xiaolan Hospital，Southern Medical University were retrospectively collected.The patients were divided into two groups according to the surgical method.78 patients were treated with stapled hemorrhoids.conventional milligan-morgan hemorrhoidectomy group，50 patients were treated with propensity score matching to balance the influence of confounding factors between the two groups，and the postoperative recurrence rate and complications of the matched patients were analyzed.Results After propensity score matching method， a total of 43 patients were successfully matched.The postoperative 2-year recurrence rate was 46.51%，which was higher than that of conventional milligan-morgan hemorrhoidectomy group 18.61%，the difference was statistically significant(P<0.05)；The patients with hemorrhoids and mucous membrane circumferential resection(23.25%)had more acute urgency than the conventional milligan-morgan hemorrhoidectomy group(4.65%)(P< 0.05).There was no significant difference in postoperative bleeding，urinary retention，urinary incontinence，anal stenosis，anal fissure， fecal incontinence，and recto-vaginal fistula(P>0.05)；In the conventional milligan-morgan hemorrhoidectomy group，the pain degree on the first day，the third day，and the second postoperative week were all stronger than those in the stapler supracondylar mucosal loop group，and the difference was statistically significant(P<0.05).The total hospitalization cost of the stapled device for prolapse and hemorrhoids was higher than that of the conventional milligan-morgan hemorrhoidectomy group，the difference was statistically significant (P<0.05).Conclusion The stapling procedure for supracondylar mucosal loop surgery is mild in the short term after 2 weeks，but the incidence of postoperative acute heaviness and postoperative 2 years recurrence rate is higher., 百拇医药(倪航航 梁志宏 刘书强 华伟 江雪峰 宋林泉)