| 摘要: |
| 目的 探讨自动痔疮套扎术(RPH)联合外痔剥离皮瓣整形在混合痔患者中的应用效果。方法:选取2020年11月—2022年8月本院收治的240例混合痔患者。采用随机数字表法分为研究组、对照组，各120例。对照组采用传统外剥内扎术，研究组采用RPH联合外痔剥离皮瓣整形。比较两组疗效、术中出血量、手术时间、创面愈合时间、术后不同时间点创面疼痛程度(VAS评分)、术前、术后1 d应激指标[促肾上腺皮质激素(ACTH)、皮质醇(COR)]水平及并发症发生情况。结果:研究组术中出血量少于对照组[(10.24±1.07)mL vs (15.21±1.16)mL]，手术时间、创面愈合时间短于对照组[(18.36±2.17)min、(15.35±3.12)d vs (25.56±2.31)min、(19.14±3.57)d]，差异有统计学意义(P＜0.05)；术后1 d、3 d、7 d，研究组VAS评分低于对照组[(5.78±1.04)分、(2.25±0.51)分、(1.37±0.48)分 vs (7.28±1.19)分、(4.54±0.87)分、(3.09±0.52)分]，差异有统计学意义(P＜0.05)；术后1 d，研究组COR、ACTH水平低于对照组[(328.65±36.79)ng/mL、(72.64±6.04)pg/mL vs (374.19±41.52)ng/mL、(86.59±7.48)pg/mL]，差异有统计学意义(P＜0.05)；研究组并发症总发生率(5.00%)低于对照组(14.17%)，差异有统计学意义(P＜0.05)。结论:RPH联合外痔剥离皮瓣整形治疗混合痔，可减少术中出血量，缩短手术时间，减轻术后疼痛、应激反应，愈合时间短，术后并发症少，疗效确切。 |
| 关键词: 自动痔套扎术 外痔剥离皮瓣整形 混合痔 疼痛 应激反应 |
| DOI：10.3969/j.issn.1007-6948.2023.05.011 |
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| 基金项目:2021年张家口市重点研发计划项目(大健康和生物医疗专项)(2121111D) |
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| Application effect of ruiyun procedure for hemorrhoids and external hemorrhoidal skin flap in patients with mixed hemorrhoids |
| MA Di,JIA Xiao-hong,DONG Mei-jie |
| Department of Proctology, Zhangjiakou Fifth Hospital, Zhangjiakou 075000, China |
| Abstract: |
| Objective To investigate the effect of Ruiyun Procedure for Hemorrhoids (RPH) and external hemorrhoids stripping skinflap plastic surgery in patients with mixed hemorrhoids. Methods A total of 240 patients with mixed hemorrhoids admitted to our hospital from November 2020 to August 2022 were selected. Random number table method was used to divide them into study group and control group, 120 cases each. The control group was treated with traditional external stripping and internal ligation, and the study group was treated with RPH+external hemorrhoidal peeling flap. The curative effect, intraoperative blood loss, operative time, wound healing time, wound pain degree at different time points after surgery (VAS score), stress index [adrenocorticotropic hormone(ACTH), cortisol(COR)] levels 1 day before and 1 day after surgery, and the incidence of complications were compared between the two groups. Results The intraoperative blood loss of the study group was less than that of the control group[(10.24±1.07)mL vs (15.21±1.16)mL], and the operative time and wound healing time of the study group were shorter than that of the control group[(18.36±2.17)min, (15.35±3.12)d vs (25.56±2.31)min, (19.14±3.57)d，P < 0.05]. The VAS score of the study group was lower than that of the control group one day, three days and seven days after surgery[(5.78±1.04), (2.25±0.51), (1.37±0.48) vs (7.28±1.19), (4.54±0.87), (3.09±0.52), P < 0.05]. 1 day after surgery, the levels of COR and ACTH[(328.65±36.79)ng/mL, (72.64±6.04)pg/mL vs (374.19±41.52)ng/mL, (86.59±7.48)pg/mL] in the research group were lower than those in the control group (P < 0.05). The total complication rate of study group(5.00%) was lower than that of control group(14.17%, P < 0.05). Conclusions RPH+ external hemorrhoids stripping skinflap plastic surgery treatment of mixed hemorrhoids, can reduce intraoperative blood loss, shorten the operation time, reduce postoperative pain, stress response, short healing time, postoperative complications less, accurate effect. |
| Key words: Ruiyun procedure for hemorrhoids external hemorrhoids stripping skinflap plastic surgery mixed hemorrhoids pain stress response |
