三种术式治疗混合痔的临床疗效比较

发布时间：2018-05-31 22:20

本文选题：回顾性研究 + 混合痔　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:痔是临床常见的疾病之一,临床以混合痔更为多见,其治法有中西医结合与中医外治法等,本课题主要通过研究PPH术、外剥内扎术及PPH术联合外剥内扎术三种术式治疗混合痔的临床疗效,并对其疗效进行分析比较,为医者治疗混合痔选择更加合理的手术方式提供参考。方法:本课题回顾性随机收集2013年1月～2014年1月期间曾于北京中医药大学东直门医院肛肠科住院行PPH术、外剥内扎术及PPH术联合外剥内扎术的患者共150例。通过整理病例资料及电话回访比较患者手术时间、术中出血、住院天数,及术后疼痛、术后出血、肛缘水肿,并对术后2年复发率进行对照研究。比较不同术式对治疗混合痔的疗效,应用SPSS19.0进行数据统计分析。结果:1.PPH术组、外剥内扎术组及PPH联合外剥内扎术组平均手术时间分别为40.7±9.43、47.2±14.53、42.6±10.16,外剥内扎术组手术时间远远多于PPH术组及PP H联合外剥内扎组,经统计学比较,P0.05,具有显著统计学意义;2.PPH术组、外剥内扎组及PPH联合外剥内扎术组术中平均出血分别为7.22±8.08、9.74±7.12、8.12±5.41,经统计学比较,P0.05,无明显差异;3.PPH术组、外剥内扎组及PPH联合外剥内扎术组平均住院天数分别为9.46±3.62、11.24±4.21、10.68±2.84,P0.05,具有统计学意义;4.三组术后创面疼痛比较,P0.05,具有统计学意义;5.三组术后创面水肿比较,PPH术组优于外剥内扎术组及PPH联合外剥内扎术组,后两组在术后第1d及第3d,创面水肿情况经统计学处理,P0.05,无明显差异,术后第7d,P0.05,具有统计学意义,PPH联合外剥内扎术组优于单纯外剥内扎术组;6.三组术后出血比较,术后第1d,PPH术组优于其它两组,P0.05,具有统计学意义,术后第3d及第7d,P0.05,无明显差异;7.三组在术后2年复发率方面,经统计学比较,P0.05,无明显差异,但PPH术组有复发病例,其它两组均无复发。结论:对于混合痔的治疗,PPH术更加符合人的生理,较外剥内扎术具有手术时间短、术中出血少、住院时间短及术后并发症少的优点,但其复发率相对外剥内扎术较高,所以PPH联合外剥内扎术治疗混合痔更值得推广。
[Abstract]:Objective: hemorrhoids is one of the most common diseases in clinic. Mixed hemorrhoids are more common in clinic. The methods of hemorrhoids are combination of traditional Chinese and Western medicine and external treatment of traditional Chinese medicine. The clinical efficacy of external stripping and internal ligation combined with external stripping and internal ligation for mixed hemorrhoids was analyzed and compared to provide a reference for doctors to choose more reasonable operation methods for mixed hemorrhoids. Methods: from January 2013 to January 2014, 150 patients who had been treated with PPH, external stripping and PPH combined external excision and internal ligation at Dongzhimen Hospital of Beijing University of traditional Chinese Medicine were collected at random. The operative time, intraoperative bleeding, hospital stay, postoperative pain, postoperative bleeding, anal edema and recurrence rate of 2 years after operation were compared. To compare the curative effect of different operation methods on mixed hemorrhoids, SPSS19.0 was used to analyze the data. Results 1. The average operative time of PPH group and PPH group was 40.7 卤9.43 卤14.53 卤42.6 卤10.16, respectively. The operative time in the external stripping and internal ligation group was much longer than that in the PPH group and the PP H combined external stripping and internal ligation group, and the average operative time in the external stripping and internal ligation group was 40.7 卤9.43 卤14.53 卤42.6 卤10.16, respectively, which was much longer than that in the PPH group and the PP H combined external stripping and internal ligation group. The mean intraoperative bleeding was 7.22 卤8.08 卤7.128 卤7.128.12 卤5.41 in the PPH group, and there was no significant difference between the two groups (P 0.05), there was no significant difference between the two groups, and there was no significant difference between the two groups in the two groups (P < 0.05), and there was no significant difference between the two groups in the mean intraoperative bleeding (P 0.05), and the mean intraoperative bleeding was 7.22 卤8.08 卤7.128.12 卤5.41 in the external stripping and internal ligation group. The average hospitalization days of the external stripping and internal ligation group and the PPH combined external stripping and internal ligation group were 9.46 卤3.62 卤11.24 卤4.21 卤10.68 卤2.84 (P 0.05), respectively. The postoperative wound pain in the three groups was significantly higher than that in the control group (P 0.05). The postoperative wound edema in the three groups was better than that in the external peeling and internal ligation group and the PPH combined external exfoliation and internal ligation group. There was no significant difference between the latter two groups on the 1st day and the 3rd day after the operation (P 0.05). On the 7th day after operation, there was statistical significance in PPH combined with external stripping and internal ligation, which was better than that in simple external stripping and internal ligation. Compared with the three groups, the PPH group on the 1st day after operation was better than the other two groups (P 0.05), and there was no significant difference between the three groups on the 3rd day and the 7th day after operation (P 0.05). There was no significant difference in the recurrence rate between the three groups in 2 years after operation (P 0.05), but there were recurrence cases in the PPH group and no recurrence in the other two groups. Conclusion: the treatment of PPH for mixed hemorrhoids is more suitable for human physiology, and has the advantages of shorter operation time, less bleeding, shorter hospital stay and less postoperative complications, but its recurrence rate is higher than that of external exfoliation and internal ligation. So PPH combined with exfoliation and internal ligation for mixed hemorrhoids is worth popularizing.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.18

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