中国现代手术学杂志2025，Vol.29Issue(3)：183-189,7.DOI:10.16260/j.cnki.1009-2188.2025.03.003
选择性痔上黏膜切除术联合保留肛管上皮治疗重度脱垂性痔病
Selective hemorrhoid mucosal resection(TST)combined with anal canal epithelial preservation in severe prolapsed hemorrhoids:a randomized controlled trial
摘要
Abstract
Objective To evaluate the clinical efficacy of selective hemorrhoid mucosal resection(tissue-selecting therapy,TST)combined with anal epithelial preservation in the treatment of severe prolapsed hemorrhoids.Methods A total of 204 patients with severe prolapsed hemorrhoids were enrolled and randomly divide into the treatment group and the control group,with 102 cases each.Selective hemorrhoid mucosal resection(TST)combined with anal epithelial preservation with TST mega-window stapler was performed in the treatment group,while stapled procedure for prolapsed and hemorrhoids(PPH)combined with external hemorrhoidectomy and low ligation was performed in the control group.The perioperative outcomes(including intraoperative resection tissue weight,intraoperative blood loss volume,operation time,12-hour postoperative urinary retention score,and 7-day postoperative anal margin edema score),postoperative VAS pain scores on postoperative days(POD)1,2,3,and 5,and 1-year outcomes(clinical efficacy,recurrence rate,anal incontinence score,and patient satisfaction)were compared between the two groups.Results Compared with the control group,the treatment group demonstrated significantly greater resected tissue weight(P＜0.001),less intraoperative blood loss(P＜0.001),and better 7-day anal margin edema scores(P＜0.001).No significant differences were observed in operation time,12-hour postoperative urinary retention scores,or postoperative VAS pain scores on POD 1,2,3,and 5(all P＞0.05).During the 1-year follow-up,the assessment of clinical efficacy showed 86 cured cases(84.3％),12 improved(11.8％),and 4 unhealed(3.9％)with 3 recurrences(2.9％)in the treatment group,compared to 66 cured(64.7％),21 improved(20.6％),and 15 unhealed(14.7％)with 13 recurrences(12.7％)in the control group.The treatment group achieved significantly better outcomes,with higher total effective rate(96.1％ vs.85.3％,P＜0.01)and lower recurrence rate(2.9％ vs.12.7％,P＜0.01).At 1-year evaluation after operation,the treatment group showed superior patient satisfaction(P＜0.01),while no significant difference was observed in anal incontinence scores between the two groups(P＞0.05).Conclusions Selective hemorrhoid mucosal resection(TST)combined with anal epithelial preservation significantly improves clinical efficacy and reduces recurrence in severe prolapsed hemorrhoids,offering advantages including minimal intraoperative bleeding,reduced postoperative complications,and superior patient satisfaction.This technique enables simultaneous treatment both internal and external hemorrhoids while better preserving anal function.关键词
重度脱垂性痔病/选择性痔上黏膜切除术/肛管上皮保留/痔上黏膜环切术Key words
severe prolapsed hemorrhoids/selective mucosal resection for hemorrhoids/anal canal epithelial preservation/procedure for prolapse and hemorrhoids引用本文复制引用
丁旭枫,季利江,蒋捷,王永通,黄华,卫军..选择性痔上黏膜切除术联合保留肛管上皮治疗重度脱垂性痔病[J].中国现代手术学杂志,2025,29(3):183-189,7.基金项目
苏州市科技发展计划项目(SKY2022018) （SKY2022018）
常熟市卫生健康委员会科技计划项目(CSWS202315,CSWS202224) （CSWS202315,CSWS202224）
