二點與四點牽引法在重度混合痔患者吻合器痔上黏膜環切術中的應用效果對比

【摘要】 目的：對比二點與四點牽引法在重度混合痔患者吻合器痔上黏膜環切術（PPH）中的應用效果。方法：選擇2020年3月—2022年8月撫州市東鄉區人民醫院收治的104例重度混合痔患者。根據隨機數字表法將其分為A組和B組，各52例。A組PPH術中采用二點牽引法，B組PPH術中采用四點牽引法。比較兩組手術相關指標、視覺模擬評分法（VAS）評分、Wexner便秘評分及術后并發癥情況。結果：A組手術時間為（32.06±4.81） min，短于B組的（36.73±4.24） min，術中出血量為（34.17±8.19）mL，少于B組的（40.36±9.23） mL（Plt;0.05）。術后3 d，A組 VAS評分為（4.89±0.75）分，低于B組的（5.32±0.83）分（Plt;0.05）。A組與B組術前及術后1個月Wexner便秘評分比較，差異均無統計學意義（Pgt;0.05）。A組術后并發癥發生率（3.85%）低于B組（17.31%）（Plt;0.05）。結論：與四點牽引法相比，PPH術中采用二點牽引法能縮短手術時間，減少術中出血量，且能減輕患者術后疼痛，減少術后并發癥。

【關鍵詞】 重度混合痔 吻合器痔上黏膜環切術 二點牽引法 疼痛 并發癥

Comparison of the Application Effects of Two-point and Four-point Traction in Procedure for Prolapse and Hemorrhoids in Patients with Severe Mixed Hemorrhoids/LE Guohua， ZHENG Lu. //Medical Innovation of China， 2023， 20（31）： 0-059

[Abstract] Objective： To compare the application effect of two-point and four-point traction in procedure for prolapse and hemorrhoids （PPH） in patients with severe mixed hemorrhoids. Method： A total of 104 patients with severe mixed hemorrhoids admitted to Dongxiang District People's Hospital of Fuzhou City from March 2020 to August 2022 were selected. According to the random number table method， they were divided into group A and group B， with 52 cases each group. Group A was given two-point traction during PPH surgery， while group B was given four-point traction during PPH surgery. The operation-related indicators， visual analogue scale （VAS） score， Wexner constipation score and the postoperative complications of the two groups were compared. Result： The operative time of group A was （32.06±4.81） min， which was shorter than （36.73±4.24） min of group B ， and the intraoperative bleeding volume was （34.17±8.19） mL， which was less than （40.36±9.23） mL of group B （Plt;0.05）. 3 days after operation， the VAS scores of group A was （4.89±0.75） points， which was lower than （5.32±0.83） points of group B （Plt;0.05）. There were no statistical significant differences in Wexner constipation scores between group A and group B before and 1 month after operation （Pgt;0.05）. The incidence of postoperative complications in group A （3.85%） was lower than that in group B （17.31%） （Plt;0.05）. Conclusion： Compared with four-point traction， two-point traction in PPH can shorten the operation time， reduce intraoperative bleeding volume， and it can alleviate postoperative pain and reduce postoperative complications for patients.

[Key words] Severe mixed hemorrhoids Procedure for prolapse and hemorrhoids Two-point traction method Pain Complication

First-author's address： Dongxiang District People's Hospital of Fuzhou City， Jiangxi Province， Fuzhou 331800， China

doi：10.3969/j.issn.1674-4985.2023.31.013

混合痔是一種臨床常見的肛腸疾病，與便秘、長期飲酒、大量食用刺激性食物有關，該癥可增加患者肛周黏液分泌，引發肛周濕疹[1-2]。輕度混合痔可選擇保守治療，但重度混合痔由于痔核嵌頓會引起肛門墜脹、疼痛等，嚴重可引起肛周皮膚潰爛、肛周膿腫，影響患者日常生活[3-4]。吻合器痔上黏膜環切術（procedure for prolapse and hemorrhoids，PPH）是治療重度混合痔的常用手術方式，具有操控性好、操作簡單等優勢，可確保痔的完全回縮[5-6]。PPH術中牽引有多種方式，早期的一點牽引法雖然簡單、易操作、耗時短，但可對患者產生較大創傷，術中常存在黏膜牽引不均勻情況，黏膜損傷風險較高，且術后出血量大，手術效果相對較差，不利于術后恢復，已不作為首選牽引方案。……