摘要
目的探讨选择性痔上黏膜切除术联合保留肛管上皮治疗重度脱垂性痔病的临床疗效。方法选择2022年1月至2023年3月我院收治的204例重度脱垂性痔病患者,随机分为治疗组和对照组,各102例,分别行选择性痔上黏膜切除术联合保留肛管上皮和吻合器痔上黏膜切除联合外痔切除低位结扎术。比较两组术中切除组织重量、术中出血量、手术时间、术后12 h尿潴留评分、术后7 d肛缘水肿评分、术后第1、2、3、5 d疼痛VAS评分等围手术期指标及术后1年临床疗效、复发率、肛门失禁评分和患者满意度。结果治疗组术中切除组织重量大于对照组,术中出血量低于对照组,术后7 d肛缘水肿评分优于对照组,均有统计学差异(P<0.001)。而两组手术时间,术后12 h尿潴留评分及术后第1、2、3、5 d疼痛VAS评分比较,均无统计学意义差异(P>0.05)。两组患者均随访1年。临床疗效评价:治疗组痊愈86例,好转12例,未愈4例,其中复发3例;对照组痊愈66例,好转21例,未愈15例,其中复发13例。治疗组总有效率明显高于对照组(96.1%vs.85.3%,P<0.01),复发率明显低于对照组(2.9%vs.12.7%,P<0.01)。术后1年治疗组患者满意度评分优于对照组(P<0.01),两组患者肛门失禁评分比较无统计学差异(P>0.05)。结论采用选择性痔上黏膜切除术联合保留肛管上皮治疗重度脱垂性痔病可以提高临床疗效,降低复发率,具有出血少,术后并发症少,患者满意度高的优点,并且可同时处理内外痔,能够更好地保护肛门功能。
Objective To evaluate the clinical efficacy of selective hemorrhoid mucosal resection(tissueselecting therapy,TST)combined with anal epithelial preservation in the treatment of severe prolapsed hemorrhoids.Methods A total of 204 patients with severe prolapsed hemorrhoids were enrolled and randomly divide into the treatment group and the control group,with 102 cases each.Selective hemorrhoid mucosal resection(TST)combined with anal epithelial preservation with TST mega-window stapler was performed in the treatment group,while stapled procedure for prolapsed and hemorrhoids(PPH)combined with external hemorrhoidectomy and low ligation was performed in the control group.The perioperative outcomes(including intraoperative resection tissue weight,intraoperative blood loss volume,operation time,12-hour postoperative urinary retention score,and 7-day postoperative anal margin edema score),postoperative VAS pain scores on postoperative days(POD)1,2,3,and 5,and 1-year outcomes(clinical efficacy,recurrence rate,anal incontinence score,and patient satisfaction)were compared between the two groups.Results Compared with the control group,the treatment group demonstrated significantly greater resected tissue weight(P<0.001),less intraoperative blood loss(P<0.001),and better 7-day anal margin edema scores(P<0.001).No significant differences were observed in operation time,12-hour postoperative urinary retention scores,or postoperative VAS pain scores on POD 1,2,3,and 5(all P>0.05).During the 1-year follow-up,the assessment of clinical efficacy showed 86 cured cases(84.3%),12 improved(11.8%),and 4 unhealed(3.9%)with 3 recurrences(2.9%)in the treatment group,compared to 66 cured(64.7%),21 improved(20.6%),and 15 unhealed(14.7%)with 13 recurrences(12.7%)in the control group.The treatment group achieved significantly better outcomes,with higher total effective rate(96.1%vs.85.3%,P<0.01)and lower recurrence rate(2.9%vs.12.7%,P<0.01).At 1-year evaluation after operation,the treatment group showed superior patient satisfaction(P<0.01),while no significant difference was observed in anal incontinence scores between the two groups(P>0.05).Conclusions Selective hemorrhoid mucosal resection(TST)combined with anal epithelial preservation significantly improves clinical efficacy and reduces recurrence in severe prolapsed hemorrhoids,offering advantages including minimal intraoperative bleeding,reduced postoperative complications,and superior patient satisfaction.This technique enables simultaneous treatment both internal and external hemorrhoids while better preserving anal function.
作者
丁旭枫
季利江
蒋捷
王永通
黄华
卫军
DING Xufeng;JI Lijiang;JIANG Jie;WANG Yongtong;HUANG Hua;WEI Jun(Department of Anorectal Surgery,Changshu Affiliated Hospital,Nanjing University of Chinese Medicine,Changshu 215500,Jiangsu,China)
出处
《中国现代手术学杂志》
2025年第3期183-189,共7页
Chinese Journal of Modern Operative Surgery
基金
苏州市科技发展计划项目(SKY2022018)
常熟市卫生健康委员会科技计划项目(CSWS202315,CSWS202224)。
关键词
重度脱垂性痔病
选择性痔上黏膜切除术
肛管上皮保留
痔上黏膜环切术
severe prolapsed hemorrhoids
selective mucosal resection for hemorrhoids
anal canal epithelial preservation
procedure for prolapse and hemorrhoids
