保留肛垫及齿状线治疗混合痔临床探究.docVIP

保留肛垫及齿状线治疗混合痔临床探究 　 作者：段君民　嵇细妹　高绍科 【摘要】 目的 探讨混合痔的有效合理治疗方案。方法 随机将88例纳入研究的混合痔患者分为治疗组和对照组，治疗组行保留肛垫及齿状线内扎外剥半缝合手术，对照组不保留肛垫及齿状线，仅行内扎外剥半缝合手术，观察术后恢复情况及并发症等。结果 治疗组在术后疼痛、肛缘水肿、肛门漏溢、漏气、狭窄等方面轻于对照组，在伤口愈合时间、治愈率方面优于对照组。结论 本术式安全有效，具有推广价值。 　　【关键词】 肛垫；齿状线；手术；临床研究 　　Clinical studies on internal ligation and external dissection with dentate line and anal cushions preserved in treatment of mixed hemorrhoids 　　【Abstract】 Objective For the purpose of observing the curative effects of the internal hemorrhoid ligation and external hemorrhoid dissection with preserved dental line and anal cushions for mixed hemorrhoids.Methods 88 case of the disease were randomized into group A (44 cases) and group B (as control group,44 cases).The patients in group A were subjected to the operation and those in group B to the traditional external hemorrhoid dissection and internal hemorrhoid ligation.The observed indexes included the healing time of the incised wound,severity of pain,edema of wound edge,peiand shin tag and anal discharge.Results The results showed that there were great differences in all the indexs between the two group (P＜0.05 for all the differences);and the curative rate of group A was much higher than that of group B (97.7% vs 89.9%,P＜0.05).Conclusion The results of the research show that the internal hemorrhoids ligation and external hemorrhoid dissection with the denate line and anal cushions preserved for mixed hemorrhoids has much advantages as good curative effects,small incised wound,few complication and simple management,and worth spreading. 　　【Key words】 anal cushions;dental line;operation;clinical studies 　　自1937年以来，混合痔的治疗术式以外剥内扎术（Millgan-Morgan）为主，1998年Lougo等报道了吻合器痔上黏膜环切术（PPH）［1］，使痔的手术发生了革命性变化。但吻合器价格昂贵，推广受到了一定的限制。我们根据现代肛垫下移学说，综合PPH及其他术式的优点，设计了保留肛垫和齿状线内外括约肌部分切断外剥内扎治疗混合痔的术式，经88例的实践，取得了良好的效果，现报告如下。 　　1 临床资料 　　1.1 一般资料 自2003年1月～2005年5月随机选择符合纳入标准的混合痔病人88例，分两组，每组44例，年龄21～78岁，平均42.7岁，病程1～41年，其中嵌顿痔8例、复发痔5例。治疗组采用内扎外剥保留肛垫和齿状线术，对照组采用内扎外剥术，两组均行内外括约肌部分切断，两组在年龄、性别、病情、病程分布上差异无显著性（P＞0.05），具有