A comparative study on the clinical efficacy and anorectal dynamics of two combined operations in the treatment of mixed hemorrhoids_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FAN Leitao ¹ , SUN Yuan ¹ ,  LI Chunyu ²

1. Department of Colorectal and Anal Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning 122000, P. R. China;
2. Department of Anorectal Surgery, The Fourth Affiliated Hospital of China Medical University, Shengyang 110032, P. R. China;

Corresponding?author：

LI Chunyu, Email: lcy133000@163.com

Keywords：

mixed hemorrhoid; tissue-selecting therapy stapler; procedure for prolapse and hemorrhoids; Milligan-Morgan; lauromacrgol injection; anorectal dynamics

DOI：

10.7507/1007-9424.202004066

Video：

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Objective To study the curative effect and postoperative anorectal dynamics change of tissue-selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) respectively combined with mixed Milligan-Morgan and lauromacrgol injection in the treatment of Ⅲ–Ⅳ degree mixed hemorrhoid.Methods Clinical data of 158 patients with Ⅲ–Ⅳdegree mixed hemorrhoid who received operation in the Department of Colorectal and Anal Surgery, Chaoyang Central Hospital, from May 2016 to March 2018 were analyzed retrospectively, the observation group (TST+Milligan-Morgan+lauromacrgol injection, 80 cases) and control group (PPH+Milligan-Morgan+lauromacrgol injection, 78 cases). The clinical efficacy, adverse reactions, postoperative complications and recurrence of the two groups were observed, and the changes of anorectal dynamic indexes before and after operation were observed.Results Postoperative symptoms of mixed hemorrhoid prolapse could be alleviated by 100% in both the observation group and the control group, and the relief rate of hematochezia was 93.8% and 92.3%, respectively, and the effective rate of 1 year after surgery was 97.5% and 94.9%, respectively. Comparison between the two groups showed no statistical difference (P>0.05). The operative time, intraoperative blood loss, VAS pain score and hospital stay of the observation group were all better than those of the control group (P<0.05). In terms of postoperative massive hemorrhage and anastomotic stenosis, although the incidence rate of the control group was higher than that of the observation group (3.8% vs. 1.3% and 2.6% vs. 0.0%, respectively), there was no statistical significance in the two groups (P>0.05). Postoperative anal drop, stool urgency, postoperative urinary retention and postoperative stimulation of anal papilla hypertrophy and proliferation complications were significantly better in the observation group than in the control group (P<0.05). The difference of maximum anal systolic pressure (MASP) in the two groups of patients between before and after surgery and the comparison of MASP results between the two groups after surgery showed no statistical differences (P>0.05). The differences of resting anal sphincter pressure (RASP) and rectal sensory threshold volume (RSTV) between before and after operation were not statistically significant (P>0.05). The difference of rectal maximum threshold volume (RMTV) value and the comparison of RASP, RSTV and RMTV value between the two groups after surgery showed that the observation group were superior to the control group and the differences were statistically significant (P<0.05).Conclusions TST or PPH combined with Milligan-Morgan and lauromacrgol injection both are effective and minimally invasive methods for the treatment of Ⅲ–Ⅳ degree mixed hemorrhoid. However, the observation group has shorter operative time and hospital stay, less intraoperative blood loss, and lower postoperative pain score. What is more important is that the postoperative complications are less and the anal function is protected to the maximum extent, and the quality of life of patients after operation is greatly improved.

Citation： FAN Leitao, SUN Yuan, LI Chunyu. A comparative study on the clinical efficacy and anorectal dynamics of two combined operations in the treatment of mixed hemorrhoids. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 79-84. doi: 10.7507/1007-9424.202004066 Copy

1.	Brown S, Tiernan J, Biggs K, et al. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation. Health Technol Assess, 2016, 20(88): 141-150.
2.	王啟, 陳會林, 劉銚, 等. 選擇性痔上黏膜切除術治療混合痔 60 例. 中國中西醫結合外科雜志, 2015, 21(1): 54-56.
3.	Elmr SE, Nygren JO, Lenander CE. A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum, 2013, 56(4): 484-490.
4.	Kim JS, Vashist YK, Thieltges S, et al. Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy in circumferential third-degree hemorrhoids: long-term results of a randomized controlled trial. J Gastrointest Surg, 2013, 17(7): 1292-1298.
5.	李春雨, 聶敏. 吻合器痔上黏膜環切術治療混合痔 68 例臨床總結. 中國肛腸病志, 2003, 23(11): 5-6.
6.	王業皇, 章陽, 嚴進, 等. 開環式微創痔吻合器治療痔病的臨床效果. 江蘇醫藥, 2010, 36(11): 1249-1250.
7.	何永恒, 肖志國, 韓金紅. 剪口結扎結合 PPH 治療混合痔的安全性多中心臨床研究. 中國普外基礎與臨床雜志, 2011, 18(3): 276-280.
8.	白金權, 李柏文. 吻合器痔上黏膜環形切除術治療老年中重度內痔的臨床效果. 中國老年學雜志, 2017, 12(37): 5904-5905.
9.	張衛平, 吳國忠, 張超杰. 吻合器痔上黏膜環形切除術與傳統外剝內扎術治療混合痔術后長期隨訪對比. 中華普通外科學文獻(電子版), 2018, 12(2): 184-187.
10.	藍興菊. 環狀混合痔行吻合器痔上黏膜環切釘合術患者的近期及遠期并發癥分析. 重慶醫學, 2015, 44(1): 110-112.
11.	賀平, 陳宏亮. 吻合器痔上黏膜環切釘合術與 Milligan-Morgan 術治療脫垂性痔的 Meta 分析. 中華胃腸外科雜志, 2015, 18(12): 1224-1229.
12.	郭良憲, 馮磊, 于志深. PPH 結合痔切除與開放式外剝內扎術治療痔瘡的效果對比分析. 航空航天醫學雜志, 2018, 29(3): 263-265.
13.	范雷濤, 谷建南, 李玉博, 等. 吻合器痔上黏膜環形切除術輔助剪口結扎治療 357 例混合痔患者的長期療效評價. 中國普外基礎與臨床雜志, 2015, 22(5): 623-625.
14.	杜仲代, 蔣應祥. TST 聯合外剝內扎術治療環狀混合痔的臨床觀察. 中國中西醫結合外雜志, 2019, 8(25): 628-630.
15.	Wang ZG, Zhang Y, Zeng XD, et al. Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy. World J Gastroenterol, 2015, 21(8): 2490-2496.
16.	劉寧. 外剝內扎術和 TST 加外剝內扎術在混合痔手術中的臨床效果對比. 臨床醫學研究與實踐, 2017, 2(3): 90-91.
17.	孫燕, 李剛, 程海鶴, 等. TST 聯合聚桂醇注射液治療Ⅱ、Ⅲ期內痔及混合痔的臨床觀察. 山東醫藥, 2018, 58(29): 78-80.
18.	劉先秒, 侯延平, 張艷華. 經結腸鏡聚桂醇硬化劑注射治療Ⅱ、Ⅲ期內痔的臨床觀察. 現代消化及介入診療, 2015, 20(3): 250-252.
19.	姚禮慶, 鐘蕓詩, 許劍民, 等. 吻合器痔上黏膜釘合術后直腸狹窄. 中華外科雜志, 2006, 44(13): 897-899.
20.	鄧業巍, 許召杰, 張勝威. TST 與 PPH 治療Ⅲ~Ⅳ度內痔的臨床療效對比分析. 中華結直腸疾病電子雜志, 2019, 8(2): 176-178.
21.	Zhang GX, Liang RW, Wang J, et al. Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and Ⅳ internal hemorrhoids (Meta-analysis). Int J Surg, 2020, 74: 53-60.
22.	Ripetti V, Caricato M, Amllani A. Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rectum, 2002, 45(2): 268-270.
23.	阮寧, 陳志華, 林夏冰. 選擇性痔上黏膜切除術與吻合器痔上黏膜環切釘合術治療重度內痔的臨床療效對比. 中華胃腸外科雜志, 2013, 16(7): 645-647.
24.	Thaha MA, Campbell KL, Kazmi SA, et al. Prospective randomised multi-centre trial comparing the clinical effificacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut, 2009, 58(5): 668-678.
25.	林玲莉, 芩嘉云, 胡立波. PPH 結合痔切除與開放式外剝內扎術治療環狀混合痔的對比研究. 中國臨床醫學, 2005, 12(6): 1058-1060.
26.	譚嗣偉, 李東冰, 張立軍, 等. 痔上黏膜非環切吻合術治療內痔. 中華普通外科雜志, 2016, 31(8): 670-672.
27.	林宏城, 任東林, 謝尚奎, 等. 選擇性痔上黏膜切除釘合術與痔上黏膜環切釘合術的對比研究. 廣東醫學, 2011, 32(11): 1457-1460.
28.	Lin HC, Ren DL, He QL, et al. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade Ⅲ–Ⅳ prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol, 2012, 16(5): 337-343.
29.	張全輝, 鄧永文, 姚玉喬. 消痔靈注射液聯合選擇性痔上黏膜吻合術對混合痔患者肛腸動力及治療效果的影響. 廣州中醫藥大學學報, 2017, 34(1): 41-46.
30.	曾慶陽, 丁正松. 比較混合痔 TST 術與 MM 手術后肛腸動力學改變及臨床意義. 影像研究與醫學應用, 2017, 1(8): 202-204.
31.	廖秀軍, 孟強, 楊關根, 等. 吻合器痔上黏膜環切釘合術加外痔切除術治療混合痔的療效分析. 中華胃腸外科雜志, 2008, 11(6): 525-528.
32.	陳戰斌, 張波, 楊曉蓓. TST 與 PPH 治療混合痔效果及對肛腸動力學的影響. 中國肛腸病雜, 2016, 36(6): 16-18.

1. Brown S, Tiernan J, Biggs K, et al. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation. Health Technol Assess, 2016, 20(88): 141-150.
2. 王啟, 陳會林, 劉銚, 等. 選擇性痔上黏膜切除術治療混合痔 60 例. 中國中西醫結合外科雜志, 2015, 21(1): 54-56.
3. Elmr SE, Nygren JO, Lenander CE. A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum, 2013, 56(4): 484-490.
4. Kim JS, Vashist YK, Thieltges S, et al. Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy in circumferential third-degree hemorrhoids: long-term results of a randomized controlled trial. J Gastrointest Surg, 2013, 17(7): 1292-1298.
5. 李春雨, 聶敏. 吻合器痔上黏膜環切術治療混合痔 68 例臨床總結. 中國肛腸病志, 2003, 23(11): 5-6.
6. 王業皇, 章陽, 嚴進, 等. 開環式微創痔吻合器治療痔病的臨床效果. 江蘇醫藥, 2010, 36(11): 1249-1250.
7. 何永恒, 肖志國, 韓金紅. 剪口結扎結合 PPH 治療混合痔的安全性多中心臨床研究. 中國普外基礎與臨床雜志, 2011, 18(3): 276-280.
8. 白金權, 李柏文. 吻合器痔上黏膜環形切除術治療老年中重度內痔的臨床效果. 中國老年學雜志, 2017, 12(37): 5904-5905.
9. 張衛平, 吳國忠, 張超杰. 吻合器痔上黏膜環形切除術與傳統外剝內扎術治療混合痔術后長期隨訪對比. 中華普通外科學文獻(電子版), 2018, 12(2): 184-187.
10. 藍興菊. 環狀混合痔行吻合器痔上黏膜環切釘合術患者的近期及遠期并發癥分析. 重慶醫學, 2015, 44(1): 110-112.
11. 賀平, 陳宏亮. 吻合器痔上黏膜環切釘合術與 Milligan-Morgan 術治療脫垂性痔的 Meta 分析. 中華胃腸外科雜志, 2015, 18(12): 1224-1229.
12. 郭良憲, 馮磊, 于志深. PPH 結合痔切除與開放式外剝內扎術治療痔瘡的效果對比分析. 航空航天醫學雜志, 2018, 29(3): 263-265.
13. 范雷濤, 谷建南, 李玉博, 等. 吻合器痔上黏膜環形切除術輔助剪口結扎治療 357 例混合痔患者的長期療效評價. 中國普外基礎與臨床雜志, 2015, 22(5): 623-625.
14. 杜仲代, 蔣應祥. TST 聯合外剝內扎術治療環狀混合痔的臨床觀察. 中國中西醫結合外雜志, 2019, 8(25): 628-630.
15. Wang ZG, Zhang Y, Zeng XD, et al. Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy. World J Gastroenterol, 2015, 21(8): 2490-2496.
16. 劉寧. 外剝內扎術和 TST 加外剝內扎術在混合痔手術中的臨床效果對比. 臨床醫學研究與實踐, 2017, 2(3): 90-91.
17. 孫燕, 李剛, 程海鶴, 等. TST 聯合聚桂醇注射液治療Ⅱ、Ⅲ期內痔及混合痔的臨床觀察. 山東醫藥, 2018, 58(29): 78-80.
18. 劉先秒, 侯延平, 張艷華. 經結腸鏡聚桂醇硬化劑注射治療Ⅱ、Ⅲ期內痔的臨床觀察. 現代消化及介入診療, 2015, 20(3): 250-252.
19. 姚禮慶, 鐘蕓詩, 許劍民, 等. 吻合器痔上黏膜釘合術后直腸狹窄. 中華外科雜志, 2006, 44(13): 897-899.
20. 鄧業巍, 許召杰, 張勝威. TST 與 PPH 治療Ⅲ~Ⅳ度內痔的臨床療效對比分析. 中華結直腸疾病電子雜志, 2019, 8(2): 176-178.
21. Zhang GX, Liang RW, Wang J, et al. Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and Ⅳ internal hemorrhoids (Meta-analysis). Int J Surg, 2020, 74: 53-60.
22. Ripetti V, Caricato M, Amllani A. Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rectum, 2002, 45(2): 268-270.
23. 阮寧, 陳志華, 林夏冰. 選擇性痔上黏膜切除術與吻合器痔上黏膜環切釘合術治療重度內痔的臨床療效對比. 中華胃腸外科雜志, 2013, 16(7): 645-647.
24. Thaha MA, Campbell KL, Kazmi SA, et al. Prospective randomised multi-centre trial comparing the clinical effificacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut, 2009, 58(5): 668-678.
25. 林玲莉, 芩嘉云, 胡立波. PPH 結合痔切除與開放式外剝內扎術治療環狀混合痔的對比研究. 中國臨床醫學, 2005, 12(6): 1058-1060.
26. 譚嗣偉, 李東冰, 張立軍, 等. 痔上黏膜非環切吻合術治療內痔. 中華普通外科雜志, 2016, 31(8): 670-672.
27. 林宏城, 任東林, 謝尚奎, 等. 選擇性痔上黏膜切除釘合術與痔上黏膜環切釘合術的對比研究. 廣東醫學, 2011, 32(11): 1457-1460.
28. Lin HC, Ren DL, He QL, et al. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade Ⅲ–Ⅳ prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol, 2012, 16(5): 337-343.
29. 張全輝, 鄧永文, 姚玉喬. 消痔靈注射液聯合選擇性痔上黏膜吻合術對混合痔患者肛腸動力及治療效果的影響. 廣州中醫藥大學學報, 2017, 34(1): 41-46.
30. 曾慶陽, 丁正松. 比較混合痔 TST 術與 MM 手術后肛腸動力學改變及臨床意義. 影像研究與醫學應用, 2017, 1(8): 202-204.
31. 廖秀軍, 孟強, 楊關根, 等. 吻合器痔上黏膜環切釘合術加外痔切除術治療混合痔的療效分析. 中華胃腸外科雜志, 2008, 11(6): 525-528.
32. 陳戰斌, 張波, 楊曉蓓. TST 與 PPH 治療混合痔效果及對肛腸動力學的影響. 中國肛腸病雜, 2016, 36(6): 16-18.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A comparative study on the clinical efficacy and anorectal dynamics of two combined operations in the treatment of mixed hemorrhoids

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