吻合器痔上黏膜环切钉合术与开放式外剥内扎痔切除术治疗Ⅲ度痔远期疗效比较

作者单位：第二炮兵总医院肛肠外科全军肛肠病专病中心，北京100088

通讯作者：赵克，E-mail：99zhujun@

论著

文章编号：1005-2208（2012）05-0398-05

吻合器痔上黏膜环切钉合术与开放式外剥内扎痔

切除术治疗Ⅲ度痔远期疗效比较

朱

军，丁健华，赵克，汤海燕，赵勇，张斌，赵玉涓，刘胜男

【摘要】目的

比较吻合器痔上黏膜环切钉合术（PPH ）与开放式外剥内扎痔切除术（MMH ）对Ⅲ度痔的远期疗

效。方法第二炮兵总医院肛肠外科对2001年5月至2004年5月间因Ⅲ度痔行PPH 的78例和MMH 的86例病人进行随访，比较两组病人术后症状缓解情况、并发症和复发情况。结果

PPH 和MMH 均明显缓解了脱垂

（93.6%vs.95.3%）、便血（95.2%vs.92.5%）及肛门下坠感（92.4%vs.94.3%）等症状，两组比较差异无统计学意义（P ＞0.05）。PPH 组术后肛门潮湿、肛门瘙痒的缓解率优于MMH 组（P ＜0.05）。PPH 和MMH 对不同类型及脱垂程度痔的缓解率比较，差异均无统计学意义（P ＞0.05）。两组术后总体并发症发生率（12.8%vs.11.6%）、复发率（10.3%vs.10.5%）及满意度（86.3vs.84.2）比较，差异也无统计学意义（P ＞0.05）。结论PPH 治疗Ⅲ度痔的远

期疗效及安全性与MMH 相同。

【关键词】痔；吻合器痔上黏膜环切钉合术；开放式外剥内扎痔切除术中图分类号：R6文献标志码：A

Comparison of long-term efficacy on Ⅲdegree hemorrhoids between procedure for prolapse and hemorrhoids and Milligan-Morgan hemorrhoidectomy

ZHU Jun ，DING Jian-hua ，ZHAO Ke ，et al.Department of Colorectal

Surgery ，the Second Artillery General Hospital of PLA ，Beijing 100088，China Corresponding author ：ZHAO Ke ，E-mail:99zhujun@ Abstract

Objective

To compare the long-term results of procedure for prolapse and hemorrhoids (PPH)and

Milligan-Morgan hemorrhoidectomy (MMH)in the treatment of Ⅲdegree hemorrhoids ．Methods

Seventy-eight

patients in PPH group and 86patients in MMH group treated from May 2001to May 2004in Department of Colorectal

Surgery ，the Second Artillery General Hospital of PLA were followed up ．All the patients suffered with Ⅲdegree hemorrhoids ．The data including symptoms relief,complication and recurrence were compared between two groups ．

Results

PPH and MMH both relieved prolapse (93.6%vs.95.3%),bleeding (95.2%vs.92.5%)and anus fall feeling

(92.4%vs.94.3%)significantly.There were no significant differences between two groups (P >0.05)．PPH relieved wet anus and pruritus ani more significantly compared with MMH (P <0.05)．No significant difference of complete relief rates between PPH group and MMH group according to different types and prolapses of hemorrhoids was found (P >0.05)．There was no significant difference in the overall complication rate (12.8%vs.11.6%),recurrence rates (10.3%vs.

10.5%)and satisfactory degree (86.3vs.84.2)between two groups as well (P >0.05)．Conclusion

The long-term

outcomes of PPH in the treatment of Ⅲdegree hemorrhoids are similar to Milligan-Morgan hemorrhoidectomy ．Keywords hemorrhoids ；procedure for prolapse and hemorrhoids ；Milligan-Morgan hemorrhoidectomy 开放式外剥内扎痔切除术（MMH ）是治疗痔的传统经典手术方式，疗效确切。而吻合器痔上黏膜环切钉合术（PPH ）近年来被广泛应用于痔的治疗。多项研究表明，与切除部分肛垫组织及肛管皮肤的MMH 相比，PPH 手术时间短，住院时间短，出血少，疼痛轻，恢复快，近期复发率和并

发症发生率低［1］，但PPH 的远期疗效尚不十分清楚。为评价PPH 治疗Ⅲ度痔的远期疗效，本文随访了2001年5月至2004年5月在第二炮兵总医院肛肠外科接受PPH 和MMH 治疗的Ⅲ度痔病人。现将随访资料总结如下。

1资料与方法

1.1一般资料（1）病例纳入标准：符合文献［2］2006版

《痔临床诊疗指南》痔诊断标准的Ⅲ度内痔及以内痔为主的混合痔病人，治疗合作，心脑血管、消化道、代谢性疾病