荷包缝合术在混合痔外剥内扎术中的应用研究

发布时间：2018-04-19 06:23

本文选题：外剥内扎术 + 荷包缝合术　；参考：《南京中医药大学》2017年硕士论文

【摘要】：背景:混合痔是肛肠外科的常见病及多发病,其中混合痔且内痔部分为Ⅲ、Ⅳ度患者常需行手术治疗。混合痔手术方式中,以传统的外剥内扎术最为经典,但该术式在一定程度上破坏了正常的肛垫组织,易致术后肛缘水肿、肛门疼痛、术后出血等并发症,破坏了肛管结构。随着微创外科理念的不断深入,既能消除病症,又能保持肛管生理解剖的术式已然成为当前的趋势。目的:从临床疗效、创面愈合时间、手术时间、住院天数及术后并发症等方面比较外剥内扎术联合荷包缝合术与外剥内扎术治疗混合痔的优劣,观察外剥内扎术联合荷包缝合术治疗混合痔对术后疼痛、出血、尿潴留等术后并发症以及创面愈合时间的影响。方法:选择符合纳入标准的混合痔且内痔部分为Ⅲ、Ⅳ度患者70例,按照简单随机数字表法,将70例混合痔患者随机分为治疗组35例与对照组35例。治疗组选用外剥内扎术联合荷包缝合术,对照组选用外剥内扎术。对两组患者术后并发症、创面愈合时间、临床疗效、手术时间及住院天数等指标进行观察。结果:经临床观察研究,两种术式治疗结果如下:①治疗组与对照组术后第1天、第3天、第5天肛门疼痛及肛缘水肿差异有统计学意义(P0.05),治疗组优于对照组;而术后第7天肛门疼痛及肛缘水肿差异无统计学意义(P0.05)。②两组患者在术后出血、排尿障碍、创面愈合时间、皮赘形成等方面比较,差异有统计学意义(P0.05),但两组患者在手术时间、住院天数、肛门直肠狭窄方面比较,差异无统计学意义(P0.05)。③两组患者在临床疗效、总体疗效方面差异无统计学意义(P0.05)。结论:运用外剥内扎术联合荷包缝合术治疗混合痔,在不影响疗效、不增加其他术后并发症的前提下,可有效减轻术后疼痛、减少术后出血、水肿、尿潴留等并发症的发生,能加速创面愈合,是一种符合现代微创理念,痛苦小、并发症少、恢复快、疗效令人满意的治疗混合痔改良术式。
[Abstract]:Background: mixed hemorrhoids is a common and frequent disease in anorectal surgery. The patients with mixed hemorrhoids and internal hemorrhoids usually need surgical treatment.In the operation of mixed hemorrhoids, the traditional external exfoliation and internal ligation is the most classic, but to a certain extent, it destroys the normal anal cushion tissue, easily causes postoperative perianal edema, anal pain, postoperative bleeding and other complications, and destroys the anal canal structure.With the development of minimally invasive surgery, it has become a trend to eliminate the disease and maintain the anus anatomy.Objective: to compare the clinical efficacy, wound healing time, operation time, hospital stay and postoperative complications in the treatment of mixed hemorrhoids.To observe the effect of external exfoliation and internal ligation combined with pocket suture on postoperative pain, bleeding, urinary retention and wound healing time in patients with mixed hemorrhoids.Methods: 70 patients with mixed hemorrhoids and internal hemorrhoids were randomly divided into treatment group (n = 35) and control group (n = 35).The treatment group was treated with external stripping and internal ligation combined with purse suture, while the control group was treated with external stripping and internal ligation.The postoperative complications, wound healing time, clinical efficacy, operation time and hospital stay were observed.Results: according to the clinical observation, the results of the two methods were as follows: the anus pain and perianal edema were significantly different between the control group and the control group on the 1st, 3rd and 5th day after operation, and the treatment group was superior to the control group.On the 7th day after operation, there was no significant difference in anal pain and perianal edema between the two groups in terms of postoperative bleeding, dysuria, wound healing time and dermatophyte formation. However, there was a significant difference between the two groups in the operation time.There was no significant difference in the days of hospitalization and anorectal stenosis between the two groups (P 0.05.3), but there was no significant difference in the overall curative effect between the two groups (P 0.05).Conclusion: the treatment of mixed hemorrhoids with exfoliation and internal ligation combined with purse suture can effectively reduce postoperative pain, bleeding, edema, urinary retention and other complications without affecting the curative effect and increasing other postoperative complications.It can accelerate wound healing, which accords with modern minimally invasive principle, with less pain, less complications, quick recovery and satisfactory curative effect in treating mixed hemorrhoids.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.18

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