摘要
目的对比观察痔激光消融术(laser hemorrhoidoplasty,LHP)与胶圈套扎术(rubber band ligation,RBL)治疗Ⅱ~Ⅲ度内痔的临床疗效。方法将2020年1月至2020年12月上海中医药大学附属岳阳中西医结合医院肛肠科收治的70例Ⅱ~Ⅲ度内痔患者随机分为两组,每组各35例,患者接受LHP或RBL治疗。记录两组术后肛门疼痛情况、肛门坠胀感(均为术后24 h内及术后第3天进行评价)及创面出血情况(术后第3、第7天进行评价),术后住院时间、术后1周内并发症(排尿困难、创面感染、肛门失禁)的发生情况及术前的肛管静息压、术后1个月的肛管静息压,以及治疗有效率与复发率。结果LHP组术后24 h内及术后第3天的肛门疼痛VAS评分均低于RBL组且肛门坠胀感均轻于RBL组,术后第7天的创面出血情况优于RBL组,差异均有统计学意义(均P<0.05);两组术后第3天的创面出血情况比较差异无统计学意义(P>0.05)。LHP组术后住院时间短于RBL组,差异有统计学意义(P<0.05)。两组术后1周内均未出现术后创面感染和肛门失禁;RBL组有6例患者出现轻度排尿困难。LHP组手术前后组内及两组手术前后组间的肛管静息压比较差异均无统计学意义(均P>0.05),RBL组术后1个月的肛管静息压高于术前(P<0.05)。两组治疗有效率均为100%。两组复发率比较差异无统计学意义(P>0.05)。结论LHP和RBL均是治疗Ⅱ~Ⅲ度内痔的有效术式,LHP有助于减轻患者术后肛门疼痛、肛门坠胀感和改善患者术后创面出血情况,也有利于患者尽早回归正常的工作与生活。
Objectives To compare the clinical efficacy of laser hemorrhoidoplasty(LHP)and rubber band ligation(RBL)in the treatment of gradeⅡtoⅢinternal hemorrhoids.Methods From January 2020 to December 2020,a total of 70 patients with gradeⅡtoⅢinternal hemorrhoids were randomly divided into two groups at the Department of Coloproctology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,each group consisted of 35 cases and received either LHP or RBL treatment.Postoperative anal pain and anal distension(evaluated within 24 hours and on the third day after surgery),wound bleeding(evaluated on the third and seventh day after surgery),post⁃operative hospital stay,occurrence of postoperative complications within one week after surgery(including dysuria,wound infec⁃tion,and anal incontinence),and preoperative and postoperative one-month anal resting pressure were recorded.The treatment ef⁃fectiveness rate and recurrence rate were also evaluated.Results The Visual Analogue Scale scores of postoperative anal pain within 24 hours and on the third day were significantly lower in the LHP group than in the RBL group(P<0.05).The LHP group also experienced milder anal distention(P<0.05).Wound bleeding on the seventh day after surgery was significantly less in the LHP group compared to the RBL group(P<0.05),although there was no statistically significant difference in wound bleed⁃ing on the third day between the two groups(P>0.05).Furthermore,the length of postoperative hospital stay was shorter in the LHP group compared to the RBL group(P<0.05).There were no cases of postoperative wound infection or anal incontinence with⁃in one week after surgery in either group.However,mild dysuria was reported by six patients in the RBL group.There was no statistically significant difference in the preoperative and postoperative one-month anal resting pressure within the LHP group or between the two groups(P>0.05).The postoperative one-month anal resting pressure in the RBL group was higher than before surgery(P<0.05).The treatment effectiveness rate was 100%in both groups,and the recurrence rate did not differ between the two groups(P>0.05).Conclusion In conclusion,both LHP and RBL are viable surgical methods for effectively treating gradeⅡtoⅢinternal hemorrhoids.LHP can help alleviate postoperative anal pain and anal distension and improve postoperative wound bleeding and is also beneficial for patients to return to normal work and life as soon as possible.
作者
金磊
吴炯
王振宜
秦凯健
吴人杰
Jin Lei;Wu Jiong;Wang Zhenyi;Qin Kaijian;Wu Renjie(Department of Coloproctology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of Coloproctology,Xiangshan TCM Hospital,Huangpu District,Shanghai 200025,China)
出处
《结直肠肛门外科》
2023年第3期274-279,共6页
Journal of Colorectal & Anal Surgery
基金
上海市科学技术委员会项目(20Y21901200)
国家自然科学基金(82004361)。
关键词
Ⅱ~Ⅲ度内痔
痔激光消融术
胶圈套扎术
“微创”手术
gradeⅡtoⅢinternal hemorrhoids
laser hemorrhoidoplasty
rubber band ligation
minimally invasive surgery
