目的 探析重度脱垂痔采用选择性痔上黏膜切除吻合术（TST）联合肛管上皮保存术治疗的效果。方法 选择2021年1—12月收治的120例重度脱垂痔患者作为研究对象,按随机数字表法均分为观察组和对照组,每组60例。观察组行TST联合肛管上皮保存术,对照组行外剥内扎术。比较两组手术时间、术中出血量、肛门坠胀情况、治疗效果、肛门功能（采用Wexner量表、Vaizey量表、Pescatori量表、AMS量表4种肛门功能评估量表评价）、术后疼痛、术后并发症发生率及生活质量。结果 观察组患者手术时间、术中出血量少于对照组,肛门坠胀评分低于对照组（P<0.05）;观察组患者治疗有效率高于对照组（P<0.05）;观察组患者Wexner量表、Vaizey量表、Pescatori量表、AMS量表评分均低于对照组（P<0.05）;观察组患者术后疼痛评分、并发症发生率均低于对照组（P<0.05）;观察组患者生活质量评分高于对照组（P<0.05）。结论 重度脱垂痔患者采用TST联合肛管上皮保存术治疗效果显著,患者的疼痛程度减轻,其肛门功能明显改善,控制患者并发症发生率,提升其综合生活水平,临床上可借鉴及推广。

Objective To explore the therapeutic effect of tissue selective therapy （TST） combined with anal epithelial preservation surgery on severe prolapsed hemorrhoids. Methods A total of 120 patients with severe prolapsed hemorrhoids admitted from January to December 2021 were divided into two groups according to random number table method, with 60 cases in each group. The observation group underwent TST combined with anal epithelial preservation, and the control group underwent external stripping and internal ligation. The operation time, intraoperative blood loss, anal distention, therapeutic effect, anal function （using Wexner scale, Vaizey scale, Pescatori scale, and AMS scale）, postoperative pain, incidence of postoperative complications, and quality of life of the two groups were compared. Results The surgical time, intraoperative bleeding, and anal distension score in the observation group were lower than those in the control group （P<0.05）. The effective rate of treatment in the observation group was higher than that in the control group （P<0.05）. The Wexner scale, Vaizey scale, Pescatori scale, and AMS scale scores of the observation group were lower than those of the control group （P<0.05）. The postoperative pain score and incidence rate of complications in the observation group were lower than those in the control group （P<0.05）. The quality of life score of the observation group was higher than that of the control group （P<0.05）. Conclusion TST combined with anal epithelial preservation has a significant effect on severe prolapsed hemorrhoids, with reduced patient pain, improved anal function, decreased complications, and elevated comprehensive quality of life. It can be referenced and promoted in clinical practice.