观察吻合器痔上黏膜适形切除钉合术治疗Ⅲ~Ⅳ度环状混合痔的临床疗效。

采用回顾性队列研究方法。收集2019年1月~2020年1月在温州医科大学附属第二医院、育英儿童医院确诊并接受手术的Ⅲ~Ⅳ度环状混合痔患者，根据手术方式的不同将患者分为适形切除组和传统痔上黏膜环切术（PPH）组。回顾性分析比较两组手术相关指标、术后1年并发症等情况。

共有275例患者符合纳入标准，77例患者接受适形切除术，198例患者接受传统PPH术，两组在性别构成、年龄、病程及痔分度等方面差异无统计学意义。适形切除组术中失血量（Z=-6.472，P＜0.01）和术后24 h疼痛评分（t=-5.152，P＜0.01）明显低于传统PPH组，手术时间（均值35.2 vs. 31.9 min，t=-2.871；P=0.004）略长于传统PPH组。但两组住院天数（t=-0.467，P＞0.05）及住院费用（t=1.141，P＞0.05）指标差异无统计学意义。适形切除组术后总体并发症发生率明显低于传统PPH组［9.1%（7/77）vs. 35.8%（71/198），χ²=19.55；P=0.000］，其中术后复发［2.6%（2/77）vs. 10.1%（20/198），χ²=4.241；P=0.039］明显低于传统PPH组，中度肛门狭窄及Ⅱ度肛门失禁程度以上并发症两组比较差异无统计学意义（P＞0.05），但轻度肛门狭窄适形切除组明显低于传统PPH组［1.3%（1/77）vs. 8.1%（16/198），χ²=3.305；P=0.069］，I度肛门失禁适形切除组明显低于传统PPH组［0%（0/77）vs. 7.1%（14/198），χ²=4.366；P=0.037］。术后慢性疼痛（P＞0.05）、术后出血（P＞0.05）、肛周分泌物（χ²=0.870，P＞0.05）、肛门坠胀感（χ²=0.010，P＞0.05）在两组间差异无统计学意义（P＞0.05）。适形切除组无术后出血、术后慢性疼痛及肛门失禁的并发症发生。

吻合器痔上黏膜适形切除钉合术可安全有效地用于Ⅲ~Ⅳ度环状混合痔的治疗，具有较轻的术后疼痛，较低的术后并发症和复发率，值得临床推广应用。

To observe the clinical effect of the treatment of grades Ⅲ~Ⅳ prolapsing hemorrhoids with conformal resection of procedure for prolapse and hemorrhoids.

A retrospective cohort study was conducted. From January 2019 to January 2020, patients with grade III~IV circumferential prolapsing hemorrhoids who were diagnosed and operated in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University were collected. According to different surgical methods, the patients were divided into conformal resection group and traditional procedure for prolapse and hemorrhoids (PPH) group. The operation related indexes and postoperative complications within 1 year of the two groups were retrospectively analyzed and compared.

A total of 275 patients met the inclusion criteria. 77 patients received conformal resection and 198 patients received traditional PPH. There was no significant difference in gender, age, course of disease and grades of hemorrhoids between the two groups. The intraoperative blood loss (Z=-6.472, P＜0.01) and 24 h postoperative pain score (t=-5.152, P＜0.01) in the conformal resection group were significantly lower than those in the traditional PPH group, and the operation time (mean 35.2 vs. 31.9 min, t=-2.871; P=0.004) was slightly longer than that in the traditional PPH group. However, there was no significant difference in hospitalization days (t=-0.467, P＞0.05) and hospitalization expenses (t=1.141, P＞0.05) between the two groups (P＞0.05). The overall incidence of postoperative complications in the conformal resection group was significantly lower than that in the traditional PPH Group [9.1%(7/77) vs. 35.8%(71/198), χ²=19.55; P=0.000], in which postoperative recurrence [2.6%(2/77) vs. 10.1%(20/198), χ²=4.241; P=0.039] was significantly lower than that of the traditional PPH group, and there was no significant difference between the two groups in the complications of moderate anal stenosis and degree II anal incontinence (P＞0.05), but the conformal resection group of mild anal stenosis was significantly lower than that of the traditional PPH Group [1.3% (1/77) vs. 8.1%(16/198), χ²=3.305; P=0.069], and the conformal resection group of degree I anal incontinence was significantly lower than that of the traditional PPH Group [0% (0/77) vs. 7.1%(14/198), χ²=4.366; P=0.037]. There was no significant difference in postoperative chronic pain (P＞0.05), postoperative bleeding (P＞0.05), perianal secretion (χ²=0.870,P＞0.05) and anal distension (χ²=0.010,P＞0.05) between the two groups (P＞0.05). There were no complications of postoperative bleeding, postoperative chronic pain and anal incontinence in the conformal resection group.

Conformal resection of procedure for prolapse and hemorrhoids is safe and effective for the treatment of III~IV prolapsing hemorrhoids, with less postoperative pain, lower postoperative complications and recurrence rate, which is worthy of clinical application.