本文選題：外剝內扎術 + 荷包縫合術��； 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：背景:混合痔是肛腸外科的常見病及多發(fā)病,其中混合痔且內痔部分為Ⅲ、Ⅳ度患者常需行手術治療�；旌现淌中g方式中,以傳統(tǒng)的外剝內扎術最為經典,但該術式在一定程度上破壞了正常的肛墊組織,易致術后肛緣水腫、肛門疼痛、術后出血等并發(fā)癥,破壞了肛管結構。隨著微創(chuàng)外科理念的不斷深入,既能消除病癥,又能保持肛管生理解剖的術式已然成為當前的趨勢。目的:從臨床療效、創(chuàng)面愈合時間、手術時間、住院天數(shù)及術后并發(fā)癥等方面比較外剝內扎術聯(lián)合荷包縫合術與外剝內扎術治療混合痔的優(yōu)劣,觀察外剝內扎術聯(lián)合荷包縫合術治療混合痔對術后疼痛、出血、尿潴留等術后并發(fā)癥以及創(chuàng)面愈合時間的影響。方法:選擇符合納入標準的混合痔且內痔部分為Ⅲ、Ⅳ度患者70例,按照簡單隨機數(shù)字表法,將70例混合痔患者隨機分為治療組35例與對照組35例。治療組選用外剝內扎術聯(lián)合荷包縫合術,對照組選用外剝內扎術。對兩組患者術后并發(fā)癥、創(chuàng)面愈合時間、臨床療效、手術時間及住院天數(shù)等指標進行觀察。結果:經臨床觀察研究,兩種術式治療結果如下:①治療組與對照組術后第1天、第3天、第5天肛門疼痛及肛緣水腫差異有統(tǒng)計學意義(P0.05),治療組優(yōu)于對照組;而術后第7天肛門疼痛及肛緣水腫差異無統(tǒng)計學意義(P0.05)。②兩組患者在術后出血、排尿障礙、創(chuàng)面愈合時間、皮贅形成等方面比較,差異有統(tǒng)計學意義(P0.05),但兩組患者在手術時間、住院天數(shù)、肛門直腸狹窄方面比較,差異無統(tǒng)計學意義(P0.05)。③兩組患者在臨床療效、總體療效方面差異無統(tǒng)計學意義(P0.05)。結論:運用外剝內扎術聯(lián)合荷包縫合術治療混合痔,在不影響療效、不增加其他術后并發(fā)癥的前提下,可有效減輕術后疼痛、減少術后出血、水腫、尿潴留等并發(fā)癥的發(fā)生,能加速創(chuàng)面愈合,是一種符合現(xiàn)代微創(chuàng)理念,痛苦小、并發(fā)癥少、恢復快、療效令人滿意的治療混合痔改良術式。
[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.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.18

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