绎 646000 PPH M-M 2008 6 ~2010 6 PPH P 48 M-M M 52 100 P M P 约 0.05 M P P 约 0.05 PPH M-M doi: 10.11842/wst.2014.04.014 R657.1 A 1 1.1 [1~4] 1.1.1 Milligan-Morgan M-M Procedure for Prolapsed and Hem 原 orrhoids PPH M-M PPH [5] PPH M- M 2008 6 ~2010 6 100 PPH P M-M M P 48 25 23 25 ~64 46.1 依 10.5 1~ 268 59 依 11III 36 IV 12 9 2 6 2 M 52 28 24 21~62 48.0 依 12.0 l~261 53 依 13III 36 IV 16 12 3 5 3 2013-07-19 2013-08-10 元 11043 PPH 元元 762
2014 绎 Vol.16 No.4 1.1.2 2006 9 1994 [6] [7] 1.1.3 18~ 65 1.1.4 I II 1.1.5 淤 于 1.2 P PPH [8] PPH03 M [9] 1 3 3 1.3 1 1.4 淤 2006 [7] 1994 = + / 伊 100% 于 1 2 3 4 盂 = /+ - 伊 100% 1.5 - [10] 763
绎 2010 6 =AC/E AC/E - 1.6 SPSS 17.0 依 x 依 s t x 2 P 约 0.05 P 约 0.01 2 2.1 P M P 约 0.01 P M M P 约 0.01 2 2.2 M P P 约 0.01 P P 约 0.01 3 2.3 M P P 约 0.05 P 约 0.01 P M 4 1 0 2 4 6 约 10 ml 10 耀 50 ml 跃 50 ml 1/4 1/2 1 约 1cm 2 x 依 s n /min / / /% /% P 48 18.5 依 3.5 ** 3.0 依 1.5 ** 7.5 依 2.0 ** 2.5 依 1.5 ** 98 8 925 依 1 238 ** 97.9 M 52 46.5 依 6.0 8 依 1.5 15.0 依 1.5 4.5 依 1.5 93 4 236 依 769 98.1 M ** P 约 0.01 764
2014 绎 Vol.16 No.4 2.4 3 P 2 M 3 M P P 约 0.05 PPH M-M 5 2.5 3 P 2 M 2 M P P 约 0.05 P M-M M M P 6 2.6 M P P 约 0.01 M 4 000 P 82.28% M 87.91%- AC/E M-M PPH 7 2.7 P 28 M 2 M P P 约 0.05 P 约 0.01 8 3 40% 90% [11] III~IV 3 n 豫 豫 P 48 112.80 依 10.57 ** 4 8.3 * 15 31.3 ** M 52 214.24 依 36.48 0 2 3.8 M * P 约 0.05 ** P 约 0.01 4 n / / P 48 78 ** 6 ** 76 8 * 4 ** 2 1 2.1 1 2.1 1 2.1 5 10.4 * 0 2 4.2 18 37.5 M 52 222 110 90 16 52 2 3 5.8 0 0 0 0 3 5.8 16 30.8 M * P 约 0.05 ** P 约 0.01 5 豫 n P 46 7 15.2 * 6 13.0 * 2 4.3 7 15.2 * 3 6.5 6 13.0 * M 49 1 2.0 1 2.0 1 2.0 1 2.0 1 2.0 1 2.0 M * P 约 0.05 765
绎 6 n / 豫 /% P 45 6 13.3 * 95.1 M 49 1 2.0 98.5 M * P 约 0.05 7 AC E/% AC/E P 8 925 82.28 100.81 ** M 4 236 87.91 48.19 M * P 约 0.01 8 % n P 48 2 4.2 * 28 58.3 ** 15 31.3 ** M 52 0 2 3.8 1 1.9 M * P 约 0.05 ** P<0.01 [12] [7] P M [13] PPH 1~2 cm M-M PPH [14] [14] P M P M M-M P PPH MM P Colquhoun S [15] Ammaturo C [16] Wilson M S [17] P M PPH PPH PPH Treitz M-M [14] P M PPH Superior Rectal Artery SRA P [18] PPH [19] PPH M-M PPH [20] M-M V Ho Y H [21] III-IV PPH SRA [22] Pescatori M [23] PPH PPH [14] M-M Microvessel Density MVD 766
2014 绎 Vol.16 No.4 PPH MVD PPH [24] PPH M-M M-M 1.., 2002,40(10) 颐 795~796. 2. 56.,2012,18(1) 颐 96~97. 3.PPH Milligan-Morgan 200.,2008,15(8) 颐 613~614. 4 Nisar P J, Acheson A G, Neal K R, et al. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized controlled trials. Dis Colon Rectum, 2004, 47(11) 颐 1837~1845. 5,,..,2009,4(5) 颐 533~534. 6.. :,1994 颐 132. 7. (2006 ).,2006,(5) 颐 461~463. 8. PPH.,2005,8(4) 颐 374. 9.( 5. :,2002 颐 570. 10.3 -.,2011,22(11) 颐 1033~1034 11,,,.PPH 160.,2009,31(9) 颐 862~864. 12.PPH 123.,2009,15 (4) 颐 264~265. 13,,,..,2005,20(3) 颐 167~169. 14.PPH Milligan-Morgan. :,2011. 15 Jayaraman S, Colquhoun P H, Malthaner R A. Stapled versus con 原 ventional surgery for hemorrhoids. Cochrane Database Syst Rev, 2006, 18(4) 颐 CD005393. 16 Ammaturo C, Tufano A, Spiniello E, et al. Stapled haemor 原 rhoidopexy vs. Milligan -Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial. G Chir, 2012, 33 (10) 颐 346~351. 17 Wilson M S, Pope V, Doran H E, et al. Objective Comparison of Stapled Anopexy and Open Hemorrhoidectomy A Randomized Con 原 trolled Trial. Dis Colon Rectum, 2002, 45(11) 颐 1437~1444. 18 Kolbert G W, Raulf F. Evaluation of Longo's technique for haemor 原 rhoidectomy by doppler ultrasound measurement of the superior rec 原 tal artery. Zentralbl Chir, 2002, 127(1) 颐 19~21. 19. ( 5 ). :,2001 颐 567. 20,..,2007,39(12) 颐 1495~1496. 21 Ho Y H, Seow -Choen F, Low J Y, et al. Randomized controlled trial of trimebutine (anal sphincter relaxane) for pain after haremor 原 rhoectomy. Br J Surg, 1977, 84(3) 颐 377~379. 22 Aigner F, Bodner G, Gruber H, et al. The vascular nature of hem 原 orrhoids. J Gastrointest Surg, 2006, 10(7) 颐 1044~1050. 23 Pescatori M, Aigner F. Stapled transanal rectal mucosectomy ten years after. Tech Colo Proctol, 2007, 11(1) 颐 1~6. 24 Ganio E,Alomare D F, Gabrielli F, et al. Prosepective randomized multi -centre trial comparing stapled with open haemorrhoidectomy. Br J Surg, 2001, 88(5) 颐 669~674. Clinical Effect Observation and Cost-effectiveness Analysis on Different Operation Types of Ring Mixed Hemorrhoids Treatment Li Jun, Li Yaling, Wen Yong, Yue Chaochi (A ffiliated Hospital of Luzhou Medical College, Luzhou 646000, China) Abstract: This study was aimed to compare clinical effect and safety of ring mixed hemorrhoids treatment with pro 鄄 cedure for prolapsed and hemorrhoids (PPH) and Milligan-Morgan (M-M) in order to evaluate their effects of health economics. Retrospective analysis was given on clinical data of 100 cases (including 48 cases in P group, 52 cases in M group) which met the inclusion criteria from June 2008 to June 2010 in the Affiliated Hospital of Luzhou Med 鄄 ical College. Statistical analysis was made on short - and long -term effect, patient satisfaction, perioperative and 767
绎 postoperative complications of two groups. The cost-effectiveness was analyzed with the effect of health economics methods. The results showed that there was no obvious difference on short-term effect between two groups. However, aspects such as surgery time, hospitalization time, back to work time, duration of pain, bleeding condition, postopera 鄄 tive pain and anal swelling in P group were significantly better than M group (P < 0.05); long-term effect and costeffectiveness in M group were obviously better than P group (P < 0.05). There was no obvious difference on inci 鄄 dence rate of adverse reaction between two groups. It was concluded that the traditional external dissection and inter 鄄 nal ligation for circumferential mixed hemorrhoids had better clinical effect of both short- and long-term with better cost-effectiveness. It is still a better surgical treatment for circular mixed hemorrhoids. Keywords: PPH, M-M, circumferential mixed hemorrhoids, clinical effect, cost-effectiveness analysis 768