摘要目的：探讨内括约肌切断联合吻合器痔上黏膜环切术（PPH）治疗重度混合痔并肛裂的可行性及有效性评价。方法对116例重度混合痔并肛裂患者进行治疗，观察组58例患者采用内括约肌切断联合PPH 切除术，对照组58例患者采用传统外剥内扎加肛裂切除术，对两组患者的疗效和治疗方法的安全性进行评价。结果观察组手术时间、住院时间、愈合时间、术后疗效评分分别为（22．5±5．3）min、（2．1±0．9）d、（9．6±2．1）d、（9．8±1．6）分，对照组分别为（35．2±6．7）min、（9．1±2．5）d、（18．4±3．7）d、（5．3±1．2）分，两组差异均有统计学意义（t ＝5．68、4．95、6．33、1．35，均 P ＜0．05）。术后第3天两组术后疼痛、出血、水肿评分差异均无统计学意义（均 P ＞0．05），但术后第7天，观察组术后疼痛、出血、水肿等评分均显著优于对照组（均 P ＜0．05）。观察组术后并发症发生率为5．17％，对照组为17．24％，两组差异有统计学意义（χ2＝4．25， P ＜0．05）。结论内括约肌切断联合 PPH 是符合现代痔治疗要求的术式，是一种安全、有效的治疗方法，对于重度混合痔合并肛裂的的治疗具有进一步推广的价值。

abstractsObjective To explore the feasibility and effectiveness of the interspincterotomy combined with PPH in the treatment of severe mixed hemorrhoids and anal fissure.Methods 116 cases of glioma patients with post-operative residual lesions were treated.The observation group of 58 patients were treated with internal sphincterotomy combined with PPH resection,while 58 cases in the control group were treated by traditional external dissection and internal ligation plus resection of anal fissure.The efficacy and safety of treatment of the two groups of patients were evaluated.Results The operation time,hospitalization time,healing time,postoperative curative effect evaluation score of the observation group were (22.5 ±5.3)min,(2.1 ±0.9)d,(9.6 ±2.1)d and (9.8 ±1.6)points,respec-tively,which of the control group were (35.2 ±6.7)min,(9.1 ±2.5)d,(18.4 ±3.7)d and (5.3 ±1.2)points, there were significant differences between the two groups(t =5.68,4.95,6.33,1.35,all P <0.05).Third days after the operation,there were no significant differences in the pain,edema,hemorrhage scores between the two groups(all P >0.05),but seventh days after the operation,the pain,edema,hemorrhage control scores of the observation group were significantly better those of the control group(all P <0.05).The complication rate of the observation group was 5.17%,which of the control group was 17.24%,there was significant difference between the two groups(χ2 =4.25, P <0.05).Conclusion The interspincterotomy combined with PPH is an operation that meeting the requirements of modern hemorrhoid treatment.It is a safe and effective treatment.It is worthy of further promotion in the treatment of severe mixed hemorrhoid and anal fissure.