ObjectiveTo 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.MethodsClinical 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.ResultsPostoperative 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).ConclusionsTST 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.
ObjectiveTo investigate the clinical effect and the incidence of postoperative complications of Milligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids.MethodsProspectively collected 120 patients with annular mixed hemorrhoids who received treatment from the Department of Colorectal Surgery of Bazhong Hospital of Traditional Chinese Medicinel during the April, 2016 to October, 2018. All of the 120 patients with annular mixed hemorrhoids were randomly divided into the experimental group and the control group, with 60 patients in each one group. Patients in the experimental group was treated with Milligan-Morgan hemorrhoids combined with reducing tension of alary incision, while patients in the control group with conventional Milligan-Morgan hemorrhoid.ResultsIn the experimental group, 49 cases were cured, 11 cases showed obvious effect; in the control group, 39 cases were cured, 20 cases showed obvious effect, and 1 case was effective. The curative effect in experimental groups was better than that of the control group (Z=–2.090, P=0.037), and the effective rates of these two group were both 100% in total. The mean healing time was (19±3) d (14–21 d) in the experimental group and (21±3) d (14–24 d) in the control group, respectively, which was better in the experimental group (Z=–13.636, P<0.001). Experimental group with lower score of wound pain, hemafecia, and anal margin edema, which were much better than control group on 1 d and 3 d after operation (P<0.05). There was no statistically significant differences on incidence of uroschesis and recurrence rate between the two groups (P>0.05).ConclusionsMilligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids has good clinical effect and deserves clinical application.
Objective To summarize the clinical effect and the key part of operation of procedure for prolapse and hemorrhoids （PPH） in treatment for severe mixed hemorrhoids or circular hemorrhoids. Method The data of 183 patients with severe mixed hemorrhoids or circular hemorrhoids underwent PPH in this hospital from August 2006 to November 2012 were analyzed retrospectively. Results The operation time was （28.5±3.1） min. The operations were successfully completed at one-stage in all the patients. The average hospital stay was 5.2 d. No postoperative bleeding， fecal incontinence， and infection happened. No recurrence and complications such as postoperative rebleeding，anal stenosis， fecal incontinence， etc were found during 1 month to 3 years of follow-up with an average 26 months. Conclusions PPH as a minimally invasive operation， every detail of it should be well performed in order to improve the clinical treatment effect and reduce complications of the patients with severe mixed hemorrhoids or circular hemorrhoids.
ObjectiveTo investigate the effect of external dissection and internal ligation, plus partial internal sphincterotomy in the treatment of mixed hemorrhoids.
MethodsDuring January 2010 to January 2012, 364 patients with mixed hemorrhoids selected for surgery were divided into two groups based on whether the patients should accept the treatment of partial internal sphincterotomy. We observed the curative effect of the two groups, including anal pain, bleeding, edema, average healing days and the anorectal stenosis after operation.
ResultsThere were statistical differences between the two groups in terms of anal pain, complication rate and hospital stay (P<0.01). The curative effect of the group treated with partial internal sphincterotomy was better than that of the other group.
ConclustionExternal dissection and internal ligation, plus partial internal sphincterotomy is a better choice in the treatment of mixed hemorrhoids, which can relieve postoperative symptoms, reduce complications and shorten treatment course.
