"分段减张加选择性内扎"改良外剥内扎术治疗Ⅲ～Ⅳ度混合痔的临床研究OA

Objective To explore the application effect of modified external dissection and internal ligation with"segmental tension reduction+selective internal ligation"in patients with grade Ⅲ～Ⅳ mixed hemor-rhoids.Methods A total of 80 patients with grade Ⅲ～Ⅳ mixed hemorrhoids who were treated in our hospi-tal from January 2024 to August 2025 were enrolled as the research objects,and they were divided into the con-trol group and the observation group by random number table method,with 40 cases in each group.The control group was treated with Milligan-Morgan hemorrhoidectomy(MMH),while the observation group was treated with modified external dissection and internal ligation with"segmental tension reduction+selective internal ligation".The operation time,intraoperative blood loss,hospital stay,wound healing time,scores of pain,edema and hematochezia at different postoperative time points,postoperative anal distension,anorectal manom-etry indicators(anal resting pressure,maximum systolic pressure,length of anal high-pressure zone),scores of Wexner anal incontinence and the 36-Item Short Form Health Survey(SF-36)before and after operation,and the incidence of postoperative complications were compared between the two groups.Results The intraop-erative blood loss of the observation group was less than that of the control group(P<0.05),and the hospital stay and wound healing time were shorter than those of the control group(P<0.05).On the 1st,3rd,5th and 7th days after operation,the scores of Visual Analogue Scale(VAS),edema and hematochezia of the observa-tion group were all lower than those of the control group(P<0.05).One month after operation(the 30th day),the anal distension score of the observation group was lower than that of the control group(P<0.001).Compared with before operation,the anal resting pressure,maximal contraction pressure and length of anal high-pressure zone of both groups on the 30th day after operation were decreased(P<0.05),and the Wexner anal incontinence score was increased(P<0.05).On the 30th day after operation,the anal resting pressure,maximal contraction pressure and length of anal high-pressure zone of the observation group were higher than those of the control group(P<0.05),and the Wexner anal incontinence score was lower than that of the con-trol group(P<0.05).One month and 6 months after operation,the SF-36 scores of both groups were increased(P<0.05),which was higher in the observation group than in the control group(P<0.05).There was no significant difference in the incidence of anal stenosis and urinary retention between the two groups(P>0.05).Conclusion Compared with MMH,modified external dissection and internal ligation with"segmen-tal tension reduction+selective internal ligation"in the treatment of grade Ⅲ～Ⅳ mixed hemorrhoids can effec-tively reduce intraoperative blood loss,shorten hospital stay and wound healing time,alleviate postoperative discomfort symptoms such as pain,edema,hematochezia and anal distension,better protect patients'anal func-tion,and improve patients'quality of life.