DGHAL治疗与同期吻合器PPH术治疗Ⅲ度混合痔的临床研究比较

摘要

Objective To evaluate the clinical efficacy of Doppler guided haemorrhoidal artery ligation (DGHAL) in treatment of Ⅲhemorrhoids,as with procedure for prolapse and hemorrhoids(PPH). Methods 60 patients with Ⅲ haemorrhoids treated by our hospital from September 2015 to September 2016 were chosen,and they were divided into PPH group(n=30) and DGHAL group(n=30) according to operation method.The clinical data including operation information,hospitalization time and cost,intraoperative bleeding,the early incidence of postoperative complications,long-term recurrence,cure rate etc. They were compared respectively between two groups. Results The intraoperative blood loss was (6.88±1.08)ml in the DGHAL group,and the hospitalization cost was 8504.24 yuan,which was significantly lower than that in the PPH group [(10.24±1.87)ml,13679.20 yuan](P<0.05). The mean time of hospitalization was (6.36±1.06) days in DGHAL group had no difference in PPH group(P>0.05). After 2 weeks,there was no significant difference between the two groups in the early complications,such as pain, urinary retention,mild anal incontinence,mild rectal stenosis,posterior hematoma and incisional edema,In the long-term follow-up of 9 months, the hemorrhagic prolapse and recurrent hemorrhage in DGHAL group were statistically significant compared with PPH group (P<0.05),while the long-term cure rate of DGHAL 27 cases and PPH group 20 cases were also statistically different (P<0.05). Conclusion Compared with PPH group in the treatment of Ⅲ hemorrhoids,DGHAL is with minimally invasive,less blood loss,low hospital costs,long-term hemorrhoid recurrence and recurrence rate of bleeding characteristics,it can be recommended as Ⅲ hemorrhoid treatment.%目的 探讨多普勒超声引导下痔动脉结扎(DGHAL)治疗与同期吻合器痔上黏膜环切(PPH)治疗Ⅲ度混合痔的比较,评价DGHAL治疗Ⅲ度混合痔的临床应用价值.方法 回顾性分析2015年9月至2016年9月收治的Ⅲ度混合痔患者60例,按照手术方式分为PPH术组(n=30),DGHAL术组(n=30),对比两组患者手术情况、住院情况、住院费用、早期并发症、远期复发及治愈等差异情况.结果 DGHAL组的术中出血量(6.88±1.08)ml、住院费用8504.24元,较PPH组术中出血量(10.24±1.87)ml、住院费用13679.20元显著减少(P<0.05);而DGHAL组手术时间(31.83±3.37)min、平均住院时间(6.36±1.06)d与PPH组手术时间(33.94±7.79)min、平均住院时间(6.50±1.25)d相比,其差异均无统计学意义(P>0.05);术后2周,两组患者的早期并发症疼痛、尿潴留、轻度肛门失禁、轻度直肠狭窄、便后出血、切口水肿相比较,差异均无统计学意义(P>0.05);术后9个月远期随访,DGHAL组痔核脱出、反复出血症状较PPH组差异具有统计学意义(P<0.05),同时远期治愈率DGHAL组与PPH组差异亦有统计学意义(P<0.05).结论 DGHAL与吻合器PPH手术治疗中度痔疮相比,DGHAL具有微创、术中出血量少、住院费用低,远期痔核脱出及反复出血复发率低特点,可作为中度痔病推荐术式.