自动弹力线套扎术联合外痔菱形切除术治疗混合痔的临床观察

Clinical Observation on the Combined Use of Automatic Elastic Thread Ligation and External Hemorrhoid Diamond Excision in the Treatment of Mixed Hemorrhoids

摘要: 目的：探讨自动弹力线套扎术联合外痔菱形切除术治疗混合痔的临床疗效，探索一种效果良好、并发症更少、易于推广的混合痔手术方式。方法：选取2024年8月~2025年4月在自贡市中医医院肛肠科住院接受手术治疗的80例混合痔患者作为研究对象，按照随机数字表法分成观察组(n = 40)、对照组(n = 40)。对照组的40例混合痔患者应用传统外剥内扎术进行治疗，观察组的40例混合痔患者采用自动弹力线套扎术联合外痔菱形切除术进行治疗。比较两组患者在总体疗效、手术相关指标、术后6 h、1天、3天、5天VAS疼痛评分及术后并发症发生情况。结果：两组在总体疗效方面比较，差异不具有统计学意义(P > 0.05)。两组手术相关指标比较，观察组患者的住院时间、创面愈合时间均短于对照组，术中出血总量少于对照组(P < 0.05)；两组手术总时长比较，差异不具有统计学意义(P > 0.05)。观察组患者在术后6 h、1天、3天、5天的VAS疼痛评分均明显低于对照组(P < 0.05)。两组患者分别比较尿潴留、术后大出血、肛门坠胀感、肛门皮赘、肛门失禁或狭窄等并发症的发生率，差异不具有统计学意义(均P > 0.05)，但观察组患者的并发症总发生率低于对照组(P < 0.05)。结论：自动弹力线套扎术联合外痔菱形切除术这一术式在治疗混合痔方面表现出良好的临床疗效。相较于传统外剥内扎术，该联合术式能够更好地保护肛门正常功能，明显缓解患者术后疼痛，缩短患者住院周期与创面愈合时间，并降低术后并发症的发生率。因此，该术式可有效提升混合痔患者的手术治疗效果，具有临床推广价值。

Abstract: Objective: To evaluate the clinical efficacy of automated elastic thread ligation combined with external hemorrhoid diamond excision in the treatment of mixed hemorrhoids, and to explore a surgical approach that offers favorable outcomes, fewer complications, and ease of dissemination. Methods: Eighty patients diagnosed with mixed hemorrhoids and admitted for surgical intervention at the Proctology Department of Zigong Traditional Chinese Medicine Hospital from August 2024 to April 2025 were enrolled. Patients were randomly assigned to either the observation group (n = 40), receiving automated elastic thread ligation combined with external hemorrhoid diamond excision, or the control group (n = 40), undergoing conventional external hemorrhoidectomy with internal ligation. Outcomes assessed included overall treatment efficacy, surgical parameters, postoperative pain scores at 6 hours, 1 day, 3 days, and 5 days using the Visual Analog Scale (VAS), and incidence of postoperative complications. Results: No statistically significant difference was observed in overall efficacy between the two groups (P > 0.05). The observation group demonstrated significantly shorter hospitalization duration and wound healing time, as well as reduced intraoperative blood loss compared to the control group (P < 0.05). There was no significant difference in total operative time between groups (P > 0.05). Postoperative VAS pain scores at 6 hours, 1 day, 3 days, and 5 days were significantly lower in the observation group (P < 0.05). The incidence rates of complications such as urinary retention, postoperative massive bleeding, anal swelling, skin tags, incontinence, or stenosis did not differ significantly (P > 0.05), although the total complication rate was lower in the observation group (P < 0.05). Conclusion: The combination of automated elastic thread ligation with external hemorrhoid diamond excision demonstrates excellent clinical efficacy in the management of mixed hemorrhoids. Compared to traditional external hemorrhoidectomy, this approach better preserves anal function, significantly alleviates postoperative pain, shortens hospitalization and wound healing times, and reduces complication rates. Therefore, this surgical modality holds promise for broader clinical application and promotion.