外剥内扎术、PPH、TST在混合痔手术中的应用 - 实用中西医结合临床.DOC

MMH、PPH、TST在混合痔手术中的应用 王伟 （四川省自贡市第一人民医院 自贡643000） 摘要：目的：探讨外剥内扎切除术（MMH）、痔上黏膜环切术（PPH）、选择性痔上黏膜环切除术（TST）治疗混合痔的临床疗效、安全性、效费比。方法：将195例混合痔患者随机分为MMH组、PPH组、TST组三组，每组65例。分别观察三组术后的疼痛评分、手术时间、住院时间、术后并发症、诊疗费用等指标。结果：MMH组、TST组、PPH组在治愈率方面无明显差异，TST组在疼痛评分、住院天数、术后出血方面均优于其他两组，TST组、PPH组在创面愈合、残留赘皮及复发方面优于MMH组，MMH组在住院费用方面明显低于TST组、PPH组。结论：MMH、PPH、TST治疗混合痔疗效确切，PPH及TST，特别是TST术后疼痛较小，恢复迅速，但治疗费用较高；针对不同的患者，采取不同的手术方式，采用个体化的治疗，更能取得更好的疗效及满意度。 关键词：混合痔；MMH；PPH；TST；手术 Application of External Dissection and Internal Ligation, PPH and TST in the Operation of Mixed Hemorrhoid WANG Wei (Zigong First Peoples Hospital of Sichuan Province Zigong643000) Abstract: Objective: To investigate the clinical efficacy, safety of external dissection and internal ligation (Milligan Morgan Hemorrhoidectomy, MMH), Procedure for Prolapse and Hemorrhoid (PPH), Tissue Selecting Therapy (TST) in the treatment of mixed hemorrhoids. Method: 195 Mixed hemorrhoid patients were randomly divided into 3 groups, 65 cases in each group, and were treated with MMH, PPH or TST respectively. In the 3 groups pain score, operative time, hospital days, postoperative complications, treatment costs and other indicators were observed after operation. Results: In MMH group, TST group and PPH group there were no significant difference in the cure rate. In TST group pain score, hospital days and postoperative hemorrhage were better than those in the other two groups, in TST group and PPH group wound healing, residual epicanthus and recurrence were superior to those in MMH group, but the cost was higher than that in MMH group. Conclusion: MMH, PPH and TST are effective in the treatment of mixed hemorrhoids, PPH and TST have advantages compared to MMH in postoperative pain and recovery pace, especially for TST, but their costs are higher, the combined use of three kinds of operation can reduce postoperative bleeding, residual epicanthus and hemorrhoids recurrence and other complications and sequelae. Key words: Mixed hemorrhoid; Milligan morgan he