悬吊黏膜下痔切除术治疗环状混合痔的临床观察
Clinical observation on lift-up submucosal hemorrhoidectomy in the treatment of annular mixed hemorrhoids
- 上海中医药大学学报 2021年35卷第4期 页码：29-34
- 作者机构：
1.上海中医药大学附属市中医医院（上海 200071）
2.江苏省常熟市中医院（江苏 常熟 215500）
- 作者简介：
朱煜璋，男，硕士，住院医师，主要从事中医药防治肛肠疾病的临床研究
郭修田，主任医师，博士生导师；E-mail：guoxiutian@126.com
- 基金信息：上海申康医院发展中心临床科技创新项目(SHDC12017119);上海市卫计委科研基金资助项目(20184Y0097);苏州市卫健委临床重点病种诊疗技术专项项目(LCZX202022)
DOI：10.16306/j.1008-861x.2021.04.005
中图分类号：
扫 描 看 全 文
朱煜璋, 丁旭枫, 李鹏, 等. 悬吊黏膜下痔切除术治疗环状混合痔的临床观察[J]. 上海中医药大学学报, 2021,35(4):29-34.
ZHU Yuzhang, DING Xufeng, LI Peng, et al. Clinical observation on lift-up submucosal hemorrhoidectomy in the treatment of annular mixed hemorrhoids[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(4):29-34.
朱煜璋, 丁旭枫, 李鹏, 等. 悬吊黏膜下痔切除术治疗环状混合痔的临床观察[J]. 上海中医药大学学报, 2021,35(4):29-34. DOI： 10.16306/j.1008-861x.2021.04.005.
ZHU Yuzhang, DING Xufeng, LI Peng, et al. Clinical observation on lift-up submucosal hemorrhoidectomy in the treatment of annular mixed hemorrhoids[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(4):29-34. DOI： 10.16306/j.1008-861x.2021.04.005.
摘要
目的：,2,比较悬吊黏膜下痔切除术与传统外剥内扎术治疗环状混合痔的临床疗效。,方法：,2,纳入90例环状混合痔患者，随机分为治疗组与对照组，每组各45例。治疗组患者采用悬吊黏膜下痔切除术治疗，对照组患者采用外剥内扎术治疗。术后3个月，评价并比较两组患者的临床疗效；术后第1、3、7、14天，评价所有患者的肛门疼痛、出血、创面水肿、肛门坠胀感、排便情况评分；术后3个月，采用Wexner量表评估患者的肛门功能，检测患者的肛管直肠压力，包括直肠静息压、肛管静息压、肛管最大收缩压；比较两组患者的手术时间、住院时间、创面愈合时间及住院费用。,结果：,2,①术后3个月，两组患者的临床总有效率均为100%，组间比较差异无统计学意义（,P,>,0.05）。②术后第1、3、7、14天，治疗组患者的肛门疼痛评分均低于对照组（,P,<,0.05，,P,<,0.01）；术后第1、3、7天，治疗组患者的出血、肛门坠胀感评分均低于对照组（,P,<,0.05，,P,<,0.01）；术后第3天，治疗组患者的创面水肿评分亦低于对照组（,P,<,0.05）。③术后3个月，治疗组患者的肛管静息压明显低于对照组（,P,<,0.01）。④治疗组患者的手术时间、住院时间、创面愈合时间较对照组均明显缩短（,P,<,0.01），住院费用较对照组明显减少（,P,<,0.01）。,结论：,2,与外剥内扎术相比，悬吊黏膜下痔切除术治疗环状混合痔具有较好的临床疗效，能够有效减轻患者术后疼痛、出血、创面水肿、肛门坠胀等症状，有助于恢复肛门功能，且具有较好的经济性。
Abstract
Objective:,2,To compare the clinical efficacy between lift-up submucosal hemorrhoidectomy and traditional Milligan-Morgan hemorrhoidectomy in the treatment of annular mixed hemorrhoids.,Methods:,2,A total of 90 patients with annular mixed hemorrhoids were included and randomly divided into the treatment group and control group, 45 cases in each group.The patients in the treatment group were treated with therapy of lift-up submucosal hemorrhoidectomy, and the patients in the control group were treated with therapy of Milligan-Morgan hemorrhoidectomy.Three months after operation, the clinical efficacy of the two groups were evaluated and compared.On the 1st, 3rd, 7th and 14th days after operation, the scores of anal pain, bleeding, wound edema, anal distension and defecation were evaluated.Three months after operation, the Wexner scale was applied to evaluate the anal function, and the indexes of anorectal pressure including rectal resting pressure, anal resting pressure and maximal anal contraction pressure were detected.The operation time, hospitalization time, wound healing time and hospitalization cost of the two groups were compared.,Results:,2,①Three months after operation, the clinical total effective rates of the two groups were 100%, with no statistically significant difference between the two groups(,P,>,0.05) .②On the 1st, 3rd, 7th and 14th days after operation, the score of anal pain in the treatment group was lower than that in the control group(,P,<,0.05,P,<,0.01) .On the 1st, 3rd and 7th days after operation, the scores of bleeding and anal distension in the treatment group were lower than those in the control group(,P,<,0.05,P,<,0.01) .On the 3rd day after operation, the score of wound edema in the treatment group was also lower than that in the control group(,P,<,0.05) .③Three months after operation, the anal resting pressure in the treatment group was significantly lower than that in the control group(,P,<,0.01) .④The operation time, hospitalization time and wound healing time in the treatment group were significantly shorter than those in the control group(,P,<,0.01), and the hospitalization cost was significantly less than that in the control group(,P,<,0.01) .,Conclusion:,2,Compared with Milligan-Morgan hemorrhoidectomy, lift-up submucosal hemorrhoidectomy shows good clinical efficacy in the treatment of annular mixed hemorrhoids, and can effectively alleviate the symptoms such as postoperative pain, bleeding, wound edema and anal distension, and restore the anal function, with good economy.
关键词
环状混合痔悬吊黏膜下痔切除术外剥内扎术
Keywords
annular mixed hemorrhoidslift-up submucosal hemorrhoidectomyMilligan-Morgan hemorrhoidectomy
references
方秀才.罗马Ⅳ功能性肠病诊断标准的修改对我国的影响[J].胃肠病学和肝病学杂志，2017，26(5)：481-483.
郭明浩.痔疮患者痔上黏膜环形切除钉合术围术期管理临床路径应用研究[J].中国医药导报，2018，15(17)：154-158.
王雪柳.选择性痔上黏膜切除钉合术配合三仁汤治疗环状混合痔的临床效果分析[J].中外医学研究，2020，18(33)：126-128.
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)：461-463.
上海市卫生局.上海市中医病证诊疗常规[M].上海：上海中医药大学出版社，2003：328.
KARCIOGLU O，TOPACOGLU H，DIKME O，et al. A systematic review of the pain scales in adults：Which to use？[J]. Am J Emerg Med，2018，36(4)：707-714.
周彦霖.长强穴药物注射对环状混合痔术后镇痛的临床研究[D].南充：川北医学院，2018.
中华中医药学会.ZYYXH/T322～341－2012中医肛肠科常见病诊疗指南[S].北京：中国中医药出版社，2012：10-13.
LODER P B，KAMM M A，NICHOLLS R J，et al. Haemorrhoids：pathology，pathophysiology and aetiology[J]. Br J Surg，1994，81(7)：946-954.
梁宏涛，何春梅，姚一博，等.散瘀止痛方熏洗治疗混合痔术后并发症的临床观察[C]//中国中西医结合学会.首届国际中西医结合大肠肛门病学术论坛暨第十二届全国中西医结合大肠肛门病学术会议论文集萃.北京：中国中西医结合学会，2007：5.
王业皇，吴燕兰.丁泽民治疗痔病临证经验探析[J].江苏中医药，2015，47(4)：1-4.
MILLIGAN E T C，MORGAN C N，JONES L E，et al. Surgical anatomy of the anal canal，and the operative treatment of haemorrhoids[J]. The Lancet，1937，230(5959)：1119-1124.
肖团有，孙锋，黄丹丹，等.脱垂性痔形成机制研究进展[J].中华实用诊断与治疗杂志，2016，30(7)：637-638.
李崇彪，黄梅，朱增威，等.氟比洛芬酯合并亚甲蓝对痔疮术后超前镇痛的疗效观察[J].北方药学，2020，17(5)：70-71.
徐志刚，王真权，蒋韬.中西医对于肛肠病术后镇痛的治疗进展[J].湖南中医杂志，2018，34(9)：199-201.
0
浏览量
179
下载量
0
CSCD
4
CNKI被引量
- 网络PDF下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
- 总访问量：10152 今日访问量：15