肛管复位隧道式外剥内悬吊术治疗肛管下垂型环状混合痔
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摘要
目的探讨肛管复位隧道式外剥内悬吊术治疗肛管下垂型环状混合痔的临床疗效。方法选取肛管下垂型环状混合痔患者120例,随机分为肛管复位隧道式外剥内悬吊术组(治疗组)、传统手术组、痔上黏膜环形切除钉合术组(PPH组),每组40例,比较3个组手术时间、住院时间、术后3 d内疼痛评分、术后并发症(肛门水肿、出血、尿潴留、肛门下坠等)发生率,术后3个月随访各组感染、肛门狭窄、大便失禁的发生情况。结果治疗组在术后3 d的疼痛方面均优于传统手术组(P<0.05),治疗组手术时间及住院时间介于另外两个组之间,且差异有统计学意义(P<0.001)。治疗组在肛门下坠方面优于另外两组(P<0.05)。在术后迟发性出血、水肿、尿潴留、感染、脓肿、肛门狭窄及大小便失禁的发生率上,3个组差异无统计学意义。结论肛管复位隧道式外剥内悬吊术在治疗肛管下垂型环状混合痔具有明显优势。
Objective To explore the clinical efficacy of anal canal reduction by external decollement through tunnel and internal suspension in the treatment of circumferential mixed hemorrhoids w ith anal canal prolapse.Methods A total of 120 cases of circumferential mixed hemorrhoids w ith anal canal prolapse w ere randomly divided into 3 groups:patients in the treatment group w ere treated w ith anal canal reduction by external decollement through tunnel and internal suspension(n=40);patients in the conventional group received traditional operation(n=40);patients in the procedure for prolapsed hemorrhoids(PPH)group w ere managed w ith procedure for prolapsed hemorrhoids(n=40).The operation time,hospital stay,pain score w ithin 3 days after operation,and incidence of postoperative complications(anal edema,hemorrhage,urine retention,rectal tenesmus)w ere compared.Three months after surgery,the incidence of infection,anal stenosis and fecal incontinence w ere follow ed up.Results The treatment group suffered less pain w ithin 3days after operation than the conventional group(P<0.05);the operation time and hospital stay of the treatment group ranked second among the three groups,and the differences w ere statistically significant(P<0.001).The treatment group had low er incidence of rectal tenesmus than the other tw o groups(P<0.05).There w ere no statistically significant differences in the incidences of delayed bleeding,anal edema,urine retention,infection,absess,anal stenosis and fecal incontinence among the three groups.Conclusion Anal canal reduction by external decollement through tunnel and internal suspension has remarkably better efficacy than the conventional operation and PPH in treating circumferential mixed hemorrhoids w ith anal canal prolapse.
Objective To explore the clinical efficacy of anal canal reduction by external decollement through tunnel and internal suspension in the treatment of circumferential mixed hemorrhoids w ith anal canal prolapse.Methods A total of 120 cases of circumferential mixed hemorrhoids w ith anal canal prolapse w ere randomly divided into 3 groups:patients in the treatment group w ere treated w ith anal canal reduction by external decollement through tunnel and internal suspension(n=40);patients in the conventional group received traditional operation(n=40);patients in the procedure for prolapsed hemorrhoids(PPH)group w ere managed w ith procedure for prolapsed hemorrhoids(n=40).The operation time,hospital stay,pain score w ithin 3 days after operation,and incidence of postoperative complications(anal edema,hemorrhage,urine retention,rectal tenesmus)w ere compared.Three months after surgery,the incidence of infection,anal stenosis and fecal incontinence w ere follow ed up.Results The treatment group suffered less pain w ithin 3days after operation than the conventional group(P<0.05);the operation time and hospital stay of the treatment group ranked second among the three groups,and the differences w ere statistically significant(P<0.001).The treatment group had low er incidence of rectal tenesmus than the other tw o groups(P<0.05).There w ere no statistically significant differences in the incidences of delayed bleeding,anal edema,urine retention,infection,absess,anal stenosis and fecal incontinence among the three groups.Conclusion Anal canal reduction by external decollement through tunnel and internal suspension has remarkably better efficacy than the conventional operation and PPH in treating circumferential mixed hemorrhoids w ith anal canal prolapse.
引文
[1]刘扬, 刘青, 杨润清, 等. PPH联合外剥内扎术及皮桥整形术治疗重度环状混合痔的临床疗效观察[J]. 中国普通外科杂志, 2015, 24(2): 297-299. doi:10.3978/j.issn.1005-6947.2015.02.029
[2]Milligan ETC, Morgan CN, Nanton LE, et al. Surgical anatomy of the anal and the operative treatment of hemorrhoids [J]. Lancet, 1937, 2: 1119-1124.
[3]Walter Whitehead. The Surgical Treatment of Hemorrhoids [J]. Br Med, 1882, 1(1101): 148-150.
[4]中华医学会外科学分会结直肠肛门外科学组、中华中医药学会肛肠病专业委员会,中国中西医结合学会结直肠肛门病专业委员会. 痔临床诊治指南(2006版)[J]. 中华胃肠外科杂志, 2006, 9(5): 416-463.
[5]Jacobs D. Clinical practice. Hemorrhoids [J]. N Engl J Med, 2014, 371(10): 944-951. doi: 10.1056/NEJMcp1204188.
[6]Saxena P, Bhakuni YS. A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease [J]. Int Surg J, 2017, 4(2): 671-676. doi:10.18203/2349-2902.isj20170211.
[7]Pirolla EH, Pirolla FJC, Ribeiro FPG. Pph and biological glue in patients with high risk of bleeding in stapled hemorrhoidopexy [J]. Arq Bras Cir Dig, 2017, 30(2): 118-121. doi:10.1590/0102-6720201700020009.
[8]汪建平. 中华结直肠肛门外科学[M]. 北京: 人民卫生出版社, 2014: 754.
[9]Medina-Gallardo A, Curbelo-Peňa Y, De Castro X, et al. Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients [J]. Int J Surg Case Rep, 2017, 30: 73-75. doi: 10.1016/j.ijscr.2016.11.018.
[10]Haksal MC, ?iftci A, Tiryaki ?, et al. Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids [J]. Turk J Surg, 2017, 33(4): 233-236. doi:10.5152/turkjsurg.2017.3493.
[11]Watson AJ, Hudson J, Wood J, et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial [J]. Lancet, 2016, 388(10058): 2375-2385. doi:10.1016/S0140-6736(16)31803-7.
[12]Cosman BC, Cajas-Monson LC, Ramamoorthy SL. Twenty years of a veterans? spinal cord injury colorectal clinic: flexible sigmoidoscopy and multiple hemorrhoid ligation [J]. Dis Colon Rectum, 2017, 60(4): 399-404. doi:10.1097/DCR.0000000000000773.
[13]Araujo SE, Horcel LA, Seid VE, et al. Long term results after stapled hemorrhoidopexy alone and complemented by excisional hemorrhoidectomy: a retrospective cohort study [J]. Arq Bras Cir Dig, 2016, 29(3): 159-163. doi:10.1590/0102-6720201600030008.
[14]Menconi C, Fabiani B, Giani I, et al. Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line [J]. Int J Colorectal Dis, 2016, 31(1): 41-44. doi:10.1007/s00384-015-2355-y.
[15]Jacobs D. Clinical practice. Hemorrhoids [J]. N Engl J Med, 2014, 371(10): 944-951. doi:10.1056/NEJMcp1204188.
[16]Lu M, Yang B, Liu Y, et al. Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation [J]. World J Gastroenterol, 2015, 21(26): 8178-8183. doi:10.3748/wjg.v21.i26.8178.
[17]Kiyomatsu T, Ishihara S, Murono K, et al. Anatomy of the middle rectal artery: a review of the historical literature [J]. Surg Today, 2017, 47(1): 14-19. doi:10.1007/s00595-016-1359-8.
[18]刘福成, 谢凯. PPH加外痔切除术治疗环状混合痔的临床研究[J]. 首都医科大学学报, 2015, 36(3): 488-490. doi:10.3969/j.issn.1006-7795.2015.03.030. LIU Fucheng, XIE Kai. Clinic research on PPH combined with external hemorrhoids resection in the treatment of circular mixed hemorrhoids [J]. Journal of Capital Medical University, 2015, 36(3): 488-490. doi:10.3969/j.issn.1006-7795.2015.03.030.
[19]Ambe PC, Wassenberg DR. Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients [J]. Patient Saf Surg, 2015, 9: 36. doi:10.1186/s13037-015-0081-6.
[20]Sun ZF, Migaly J. Review of hemorrhoid disease: presentation and management [J]. Clin Colon Rectal Surg, 2016, 29(1): 22-29. doi:10.1055/s-0035-1568144.
[21]Moult HP, Aubert M, De Parades V. Classical treatment of hemorrhoids [J]. J Visc Surg, 2015, 152(2 Suppl): S3-S9. doi:10.1016/j.jviscsurg.2014.09.012.
[2]Milligan ETC, Morgan CN, Nanton LE, et al. Surgical anatomy of the anal and the operative treatment of hemorrhoids [J]. Lancet, 1937, 2: 1119-1124.
[3]Walter Whitehead. The Surgical Treatment of Hemorrhoids [J]. Br Med, 1882, 1(1101): 148-150.
[4]中华医学会外科学分会结直肠肛门外科学组、中华中医药学会肛肠病专业委员会,中国中西医结合学会结直肠肛门病专业委员会. 痔临床诊治指南(2006版)[J]. 中华胃肠外科杂志, 2006, 9(5): 416-463.
[5]Jacobs D. Clinical practice. Hemorrhoids [J]. N Engl J Med, 2014, 371(10): 944-951. doi: 10.1056/NEJMcp1204188.
[6]Saxena P, Bhakuni YS. A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease [J]. Int Surg J, 2017, 4(2): 671-676. doi:10.18203/2349-2902.isj20170211.
[7]Pirolla EH, Pirolla FJC, Ribeiro FPG. Pph and biological glue in patients with high risk of bleeding in stapled hemorrhoidopexy [J]. Arq Bras Cir Dig, 2017, 30(2): 118-121. doi:10.1590/0102-6720201700020009.
[8]汪建平. 中华结直肠肛门外科学[M]. 北京: 人民卫生出版社, 2014: 754.
[9]Medina-Gallardo A, Curbelo-Peňa Y, De Castro X, et al. Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients [J]. Int J Surg Case Rep, 2017, 30: 73-75. doi: 10.1016/j.ijscr.2016.11.018.
[10]Haksal MC, ?iftci A, Tiryaki ?, et al. Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids [J]. Turk J Surg, 2017, 33(4): 233-236. doi:10.5152/turkjsurg.2017.3493.
[11]Watson AJ, Hudson J, Wood J, et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial [J]. Lancet, 2016, 388(10058): 2375-2385. doi:10.1016/S0140-6736(16)31803-7.
[12]Cosman BC, Cajas-Monson LC, Ramamoorthy SL. Twenty years of a veterans? spinal cord injury colorectal clinic: flexible sigmoidoscopy and multiple hemorrhoid ligation [J]. Dis Colon Rectum, 2017, 60(4): 399-404. doi:10.1097/DCR.0000000000000773.
[13]Araujo SE, Horcel LA, Seid VE, et al. Long term results after stapled hemorrhoidopexy alone and complemented by excisional hemorrhoidectomy: a retrospective cohort study [J]. Arq Bras Cir Dig, 2016, 29(3): 159-163. doi:10.1590/0102-6720201600030008.
[14]Menconi C, Fabiani B, Giani I, et al. Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line [J]. Int J Colorectal Dis, 2016, 31(1): 41-44. doi:10.1007/s00384-015-2355-y.
[15]Jacobs D. Clinical practice. Hemorrhoids [J]. N Engl J Med, 2014, 371(10): 944-951. doi:10.1056/NEJMcp1204188.
[16]Lu M, Yang B, Liu Y, et al. Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation [J]. World J Gastroenterol, 2015, 21(26): 8178-8183. doi:10.3748/wjg.v21.i26.8178.
[17]Kiyomatsu T, Ishihara S, Murono K, et al. Anatomy of the middle rectal artery: a review of the historical literature [J]. Surg Today, 2017, 47(1): 14-19. doi:10.1007/s00595-016-1359-8.
[18]刘福成, 谢凯. PPH加外痔切除术治疗环状混合痔的临床研究[J]. 首都医科大学学报, 2015, 36(3): 488-490. doi:10.3969/j.issn.1006-7795.2015.03.030. LIU Fucheng, XIE Kai. Clinic research on PPH combined with external hemorrhoids resection in the treatment of circular mixed hemorrhoids [J]. Journal of Capital Medical University, 2015, 36(3): 488-490. doi:10.3969/j.issn.1006-7795.2015.03.030.
[19]Ambe PC, Wassenberg DR. Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients [J]. Patient Saf Surg, 2015, 9: 36. doi:10.1186/s13037-015-0081-6.
[20]Sun ZF, Migaly J. Review of hemorrhoid disease: presentation and management [J]. Clin Colon Rectal Surg, 2016, 29(1): 22-29. doi:10.1055/s-0035-1568144.
[21]Moult HP, Aubert M, De Parades V. Classical treatment of hemorrhoids [J]. J Visc Surg, 2015, 152(2 Suppl): S3-S9. doi:10.1016/j.jviscsurg.2014.09.012.
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