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目的 比较“牵开式”改良吻合器痔上黏膜环切钉合术(PPH)与传统手术治疗重度痔的临床疗效.方法 内痔和混合痔患者58例,根据患者住院号末尾数字进行分组,其中28例奇数者实施创新设计的“牵开式”改良PPH术(改良组),30例偶数者行传统PPH术(传统组).比较两组患者手术相关情况及随访结果.结果 所有患者术中均未出现严重并发症.改良组手术时间、术中出血量和住院时间分别为(32.5 ±9.8) min、(8.6±2.1)rml和(2.8±0.7)天,传统组分别为(40.6 ±8.7)min、(13.5 ±4.5)ml和(3.3±0.9)天,两组比较差异有统计学意义(P＜0.05).两组患者尿潴留发生率分别为17.86％和23.33％,两组比较差异无统计学意义(P＞0.05).两组患者术后肛门疼痛、便血、肛门水肿及肛门坠胀感评分均呈逐渐下降趋势,且改良组术后第1、3、7天各项并发症评分均低于传统组,其中两组术后第1、3天各项并发症评分比较差异有统计学意义(P＜0.05).术后6个月随访,两组患者均未出现肛门失禁、肛门狭窄、复发等远期并发症.两组患者的治愈率分别为100.0％和90.0％,两组比较差异无统计学意义(P＞0.05).结论 “牵开式”改良PPH术治疗重度痔安全而有效,与传统手术比较,操作空间大,术野暴露好,术后并发症轻,术后恢复快.“,”Objective To compare the clinical efficacy between pulled procedure for prolapse and hemorrhoids (PPH)and traditional PPH in the treatment of severe hemorrhoids.Methods 58 cases with internal or mixed hemorrhoid were elected.They were divided into improved group(n =28)underwent pulled PPH and traditional group (n =30) underwent traditional PPH according to number odd and even hospital numbers.The conditions related to surgery and follow-up information between two groups were compared.Results All of the patients underwent the operation without serious intraoperative complications.In the improved group,the operative time [(32.5 ± 9.8) rain vs.(40.6 ± 8.7) rain],blood loss [(8.6 ± 2.1) ml vs.(13.5 ± 4.5)] and hospital stay [(2.8 ± 0.7) d vs.(3.3 ± 0.9) d] were significant lower than those in the traditional group (P ＜ 0.05).No difference in the incidence of uroschesis (17.86％ vs.23.33％)between the two groups was found(P =0.760).The scores of postoperative pain,hemafecia,edema and sensation of rectal tenesmus in the two groups reduced gradually.The scores of all items were lower in the improved group were lower than those in the traditional group on the 1st,3rd and 7th day postoperatively,but only the differences in them between the two groups on the 1st and 3rd day postoperatively were significant (P ＜ 0.05).After 6-month follow-up,there was no patient with anal incontinence,stenosis or replase.The difference in cure rate (100％ vs.90％) between the two groups was not statistical (P =0.972).Conclusions Pulled PPH in the treatment of severe hemorrhoids is safe and efficacious.Compared with traditional surgery,it has the advantages with larger operation space,better surgical field exposure,less complications and faster recovery.