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目的:评价痔上黏膜环切钉合术对Ⅳ度内痔的疗效。方法:将62例Ⅳ度内痔患者随机分为痔上黏膜环切钉合术组(PPH组)和闭合式痔切除术组(切除组),比较两组的术后疼痛评分、早期并发症及随访1年后的结果。结果:PPH组术后疼痛评分明显低于切除组;术后早期并发症两组无差异;1年随访PPH组术后痔脱垂12例、肛门瘙痒12例、肛周皮赘18例、里急后重10例,与痔切除组比较差异有显著意义(P<0.05);PPH组术后促便感3例,痔切除组1例,术后便血两组均有2例,两组均无疼痛及肛门失禁,两组差异无显著意义。结论:对于Ⅳ度内痔,PPH目前尚不能完全取代痔切除术。在PPH的同时必须附加有限度的痔切除术或肛周皮赘切除才能有效地缓解症状,同时要告知患者可能出现的对排便功能的影响。
Objective: To evaluate the curative effect of hemorrhoids and mucosal circumcision on IV grade hemorrhoids. Methods: Sixty - two patients with grade Ⅳ internal hemorrhoids were randomly divided into hemorrhoids group (PPH group) and closed hemorrhoidectomy group (resection group). The postoperative pain scores, early complications, Follow-up results after 1 year. Results: Postoperative pain score in PPH group was significantly lower than that in resection group. There was no difference in early postoperative complications between the two groups. One year follow-up postoperative hemorrhoids prolapse in PPH group, 12 cases, anal itching in 12 cases, perianal skin flap in 18 cases, There were significant differences between the two groups (P <0.05). There were 3 cases in the PPH group after operation, 1 case in the hemorrhoidectomy group and 2 cases in the hematochezia group after operation. There was no pain in the two groups Anal incontinence, no significant difference between the two groups. Conclusion: For grade IV hemorrhoids, PPH can not completely replace hemorrhoidectomy at present. PPH must be accompanied by a limited number of hemorrhoidectomy or perirenal excision in order to effectively alleviate the symptoms, at the same time to inform the patient may appear on the defecation function.