比较选择性痔上黏膜吻合术（TST）与吻合器痔上黏膜环切术（PPH）治疗重度混合痔的效果。

收集2018年6月至2019年6月北京中医医院顺义医院肛肠科收治的108例重度混合痔患者的临床资料，根据手术方式分为TST组（59组）与PPH组（49例），比较2组患者术中出血量、手术时间、术后24 h疼痛程度、术后住院时间、治疗效果、术后并发症及复发情况。

TST组术中出血量［（29.23±9.64）ml］少于PPH组［（38.54±3.92）ml］，差异有统计学意义（P=0.026）；TST组手术时间［（31.36±10.45）min］、住院时间［（5.25±1.83）d］均短于PPH组［（35.04±9.37）min、（6.24±1.49）d］，差异均有统计学意义（P=0.021、0.012）；2组术后疼痛评分差异无统计学意义［（4.32±1.41）分vs（5.94±1.74）分，P=0.053］。治疗效果方面，2组治疗总有效率差异无统计学意义（94.9% vs 89.8%，P=0.072）。与PPH组相比，TST组肛门疼痛、肛门狭窄及便血症状均较轻微，差异均有统计学意义（P均＜0.05）。TST组术后1年复发率低于PPH组，差异有统计学意义（8.7% vs 11.6%，P=0.042）；2组术后2年复发率差异无统计学意义（18.4% vs 20.0%，P=0.068）。

TST和PPH治疗重度混合痔的远期效果相似，但在相同条件下，TST术中出血量更少、手术及住院时间更短、并发症轻微，值得临床推广。

To compare the efficacy of tissue-selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in the treatment of severe mixed hemorrhoids.

The clinical data of 108 patients with severe mixed hemorrhoids admitted to Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine from June 2018 to June 2019 were collected. The patients were divided into either TST group (59 cases) or PPH group (49 cases) according to surgical methods used. The amount of intraoperative blood loss, operative time, pain degree 24 h after surgery, postoperative hospital stay, treatment effect, postoperative complications and recurrence were compared between the two groups.

The amount of intraoperative blood loss in the TST group [(29.23±9.64) ml] was significantly less than that in PPH group [(38.54±3.92) ml; P=0.026]. The operative time [(31.36±10.45) min] and hospital stay [(5.25±1.83) d] in the TST group were significantly shorter than those in the PPH group [(35.04±9.37) min and (6.24±1.49) d, respectively; P=0.021 and 0.012, respectively]. There was no significant difference in postoperative pain score between the two groups [(4.32±1.41) points vs (5.94±1.74) points, P=0.053]. In terms of treatment effect, there was no significant difference in the total effective rate between the two groups (94.9% vs 89.8%, P=0.072). Compared with the PPH group, the symptoms of anal pain, anal stenosis, and hematochezia in the TST group were significantly milder (P＜0.05 for all). The 1-year recurrence rate in the TST group was significantly lower than that in the PPH group (8.7% vs 11.6%, P=0.042). There was no significant difference in the 2-year recurrence rate between the two groups after surgery (18.4% vs 20.0%, P=0.068).

TST and PPH have similar long-term effects in the treatment of severe mixed hemorrhoids, but under the same conditions, TST is associated with less intraoperative blood loss, shorter duration of operation and hospitalization, and minor complications, which is worthy of clinical promotion.