摘要
目的观察吻合器痔上黏膜环形切除术(PPH)治疗重度痔疮的疗效及其对患者疼痛应激与肛肠动力学的影响。方法收集2013年2月至2016年5月期间于广东省开平市第二人民医院就诊的重度痔疮患者150例,根据患者入院时间分为两组,PPH组和对照组,PPH组患者采用吻合器痔上黏膜环形切除术切除痔疮,对照组采取外剥内扎术治疗。比例两组间疗效差异;分别于术后1 h、8 h、24 h、2 d、4 d、7 d采用视觉模拟评分法(VAS)评估疼痛程度;于术前及术后d3、d7检测血清疼痛应激指标水平,行肛肠动力学检测测定肛肠动力学指标,比较组间差异。结果 PPH手术时间(21.43±6.09)min、创面愈合时间(6.27±1.29)d、住院时间(4.01±0.73)d较对照组[(35.76±9.83)min、(13.42±4.16)d、(9.34±1.28)d]缩短,差异有统计学意义(P=0.000),PPH术中出血量(14.09±6.19)mL较对照组的(36.73±9.28)mL减少,差异有统计学意义(P=0.000)。术后1 h、8 h、24 h、2 d、4 d、7 d PPH组患者VAS评分均低于对照组,差异有统计学意义(P=0.000)。术后d3、d7,PPH组患者血清疼痛应激指标SP、NPY、PGE2、IL-6、NGF水平均低于对照组,差异有统计学意义(P=0.000)。术后PPH组MSP、HPZ、MTV高于对照组,差异有统计学意义(P=0.036,0.031,0.006),而RRP、AIRT则低于对照组,差异有统计学意义(P=0.000,0.004)。结论相比于外剥内扎术,PPH术治疗重度痔疮患者术后疼痛应激小,对患者肛肠动力学影响小,具有创伤小、术后恢复快的优点。
Objective To observe the effeCT of procedure for prolapse and hemorrhoids（ PPH） in the treatment of patients with severe hemorrhoids,and its effeCTs on pain stress and anoreCTal dynamics. Methods One hundred and eighty cases of patients with severe hemorrhoids in Kaipiing Second People＇s Hospital from February 2013 to May 2016 were randomly assigned into PPH group and control group according to the patient＇s admission time. Patients in the PPH group were treated with procedure for prolapse and hemorrhoids,while patients in control group were treated with the Milligan-Morgan operation. Then the difference of curative effeCT between the two groups was compared; the degree of pain was evaluated by visual analogue scale（ VAS） at 1 h,8 h,24 h,2 d,4 d,7 d after operation;the level of serum pain stress indexes and anoreCTal dynamics indexes were deteCTed before and 1 and 3 days after surgery; the anoreCTal motility was measured by anoreCTal motility,and the difference between groups was compared. Results The operation time [（ 21. 43 ±6. 09） min],wound healing time [（ 6. 27 ± 1. 29） d],hospital stay time [（ 4. 01 ± 0. 73） d] of PPH group were shorter than control group[（ 35. 76 ± 9. 83） min,（ 13. 42 ± 4. 16） d,（ 9. 34 ± 1. 28） d],the difference was statistically significant（ P = 0. 000）,while amount of bleeding during operation was less than control group [（ 14. 09 ± 6. 19） mL vs.（ 36. 73 ± 9. 28） mL]（ P = 0. 000）. The VAS score of PPH group were lower than control group at 1 h,8 h,2 4 h,2 d,4 d,7 d after operation（ P = 0. 0 0 0）. At 3 and 7 days after operation,the levels of serum pain stress such as SP,NPY,PGE2,IL-6 and NGF in PPH group were significantly lower than those in control group（ P = 0. 000）. The MSP,HPZ and MTV in PPH group were significantly higher than those in control group（ P = 0. 036,0. 031,0. 006）,while AIRT and RRP were significantly lower than those in control group after the operation（ P = 0. 000,0. 004）. Conclusions Compared with Milligan-Morgan,PPH in patients with severe hemorrhoids showed lower influence on pain stress and anoreCTal dynamics,and has the advantages of small trauma,rapid postoperative recovery.
作者
谢浩亮
余栋栽
XIE Haoliang;YU Dongzai(Surgery Department,Kaipiing Second People＇s Hospital,Kaiping Guangdong 529300,China;ICU,Kaiping Central Hospital,Kaiping,Guangdong 529300,China)
出处
《安徽医药》
CAS
2018年第10期1929-1932,共4页
Anhui Medical and Pharmaceutical Journal
