| 摘要: |
| 目的:探究不同顺序吻合器痔上黏膜环切术(PPH)对环状混合痔合并肛裂患者的影响。方法:选取2020年11月—2024年4月我院收治的120例环状混合痔合并肛裂患者，根据手术操作顺序不同分为先PPH组(先行PPH，再行肛裂切除缝合术)与后PPH组(先行肛裂切除缝合术，再行PPH)。对比两组患者围手术期指标(手术时间、首次排便时间、首次排便在术后24~48 h内例数、住院时间)，手术并发症发生率，术后1、3、7 d疼痛情况[视觉模拟评分(VAS评分)]、术前及术后7 d排便情况[便秘患者症状自评量表(PAC-SYM)评分]、肛门情况(肛管静息压、直肠静息压、肛门直肠反射阳性率)。结果:先PPH组的手术时间、首次排便时间及住院时间显著短于后PPH组，首次排便在术后24~48 h内比例显著大于后PPH组，先PPH组手术并发症发生率(11.67%)显著低于后PPH组(26.67%)，差异均有统计学意义(P <0.05)。术后7 d内，两组患者VAS评分逐渐下降，且先PPH组术后1、3、7 d VAS评分显著低于后PPH组(P <0.05)。术后7 d，两组PAC-SYM评分显著下降，且先PPH组各项目评分显著低于后PPH组(P <0.05)。术后7 d，两组肛管静息压、直肠静息压显著上升，且先PPH组肛管静息压显著大于后PPH组(P <0.05)。先PPH组术后7 d肛门直肠反射阳性率显著大于后PPH组(P <0.05)。结论:相较先行肛裂切除缝合术，先行PPH可治疗环状混合痔合并肛裂，在降低术后疼痛感，改善患者排便情况与肛门功能方面具有明显优势。 |
| 关键词: 肛裂 环状混合痔 肛裂切除缝合术 吻合器痔上黏膜环切术 肛门功能 |
| DOI：10.3969/j.issn.1007-6948.2024.06.018 |
| 投稿时间：2024-06-16 |
| 基金项目:四川省卫生和计划生育委员会科研课题(18PJ489) |
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| The influencet of different sequences of PPH on patients with mixed hemorrhoids and anal fissures |
| YANG Bo,XIA Xu |
| Department of Gastrointestinal Hernia and Anorectal Surgery, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 Hospital,Chengdu610051, China |
| Abstract: |
| Objective To explore the influence of different sequences of procedure for prolapse and hemorrhoids (PPH) on patients with mixed hemorrhoids and anal fissures. Methods 120 patients with annular mixed hemorrhoids and anal fissure admitted from November 2020 to April 2024 were retrospectively analyzed. According to the different surgical operation method, they were divided into pre-PPH group (PPH first, then anal fissure resection suture) and post-PPH group (anal fissure resection suture first, then PPH), and 60 cases were included in each group. The perioperative indicators (surgical time, first defecation time, number of cases with first defecation within 24-48 h, hospitalization time), incidence rates of surgical complications, pain status (VAS) at 1, 3 and 7 days after surgery, defecation status (PAC-SYM) and anal status (anal resting pressure, rectal resting pressure, positive rate of anorectal reflex) before surgery and at 7 days after surgery were compared between groups. Results The surgical time, first defecation time and hospitalization time in pre-PPH group were significantly shorter than those in post-PPH group (P <0.05), and the number of cases with first defecation within 24-48 h was significantly more than that in post-PPH group (P <0.05). The total incidence rate of surgical complications in pre-PPH group (11.67%) was significantly lower than that in post-PPH group (26.67%) (P <0.05). Within 7 days after surgery, VAS in both groups was decreased gradually, and the score at each time period was significantly lower in pre-PPH group than that in post-PPH group (P <0.05). The PAC-SYM scores in both groups were declined significantly at 7 days after surgery, and the scores in pre-PPH group were significantly lower than those in post-PPH group (P <0.05). The anal canal resting pressure and rectal resting pressure in the two groups at 7 days after surgery were significantly increased, and the anal canal resting pressure in pre-PPH group was significantly higher than that in post-PPH group (P <0.05). The positive rate of anorectal reflex at 7 days after surgery was significantly higher in pre-PPH group (P <0.05). Conclusion Compared with first anal fissure resection suture, first PPH can treat annular mixed hemorrhoids with anal fissure, and the latter one has more obvious advantages in reducing postoperative pain and improving defecation status and anal function. |
| Key words: Anal fissure annular mixed hemorrhoids anal fissure resection suture procedure for prolapse and hemorrhoids anal function |
