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Problems Concerning the Treatment of Hemorrhoids from PPH

目的：總結吻合器痔上黏膜環切術（PPH）治療痔病的經驗。探討該術式的有關問題，以便提高療效。方法：回顧性分析了2001～2006年8月收治痔病541例，其中PPH術42例的臨床資料。本組均為Ⅲ度或Ⅳ度痔。局部合并癥共22例次：血栓外痔愈合后遺留皮贅14例，肛裂2例。有關全身合并癥：前列腺增生7例，慢性泌尿系統感染1例。結果:42例中，35例術后2～5天出院，6例自愿留院到7天，1例慢性尿路感染者術后2～7天多次便血，再次手術后28日痊愈出院。隨訪13～24個月：32例恢復滿意，10例有肛門包塊感及包塊排糞時輕度脫出，其中3例經進一步處理緩解，另7例觀察治療。結論:(1)PPH手術簡單易行，疼痛輕，住院時間短，效果好。(2)為了提高效果術中應注意：①禁忌癥為單個痔塊脫出和肛管皮膚不平滑并纖維化的Ⅳ度病變者外。我們還發現慢性泌尿系統感染未徹底治愈者也應視為相對禁忌。明顯前列腺增生者也應慎重。②術中按經典PPH手術的要求進行操作，擴肛器插入前后，不宜擴肛和下牽痔塊。③個別巨大痔塊及皮贅性痔塊（tag）宜先行切除，再行本術。④重度脫出者，黏膜切除應寬大，必要時切除部分肛墊。

Recent Research of Doppler-Guided Hemorrhoidal Artery Ligation in Treatment of Hemorrhoids

ObjectiveTo summarize the research progression of Doppler-guided hemorrhoidal artery ligation in the treatment of hemorrhoids. MethodsThe related literatures in recent years were reviewed, and to investigate the operation principle, operation process, the indications and effects, and existing problems of Doppler-guided hemorrhoidal artery ligation. ResultsThe surgical principle of Doppler-guided hemorrhoidal artery ligation make use of Doppler ultrasound looking for hemorrhoidal artery, and ligation it directly.It's best indication is Ⅱ or Ⅲ degree hemorrhoids or mixed hemorrhoid with grade Ⅰ or Ⅲ mainly, especially for bleeding hemorrhoids disease curative effect is better.This surgical method has lots of advantages, such as less invasive, quick recovery, and low incidence of complications.But it is no significant treatment effect for the external hemorrhoids, therefore, the procedure does not apply to external hemo-rrhoids and mixed hemorrhoids dominated by external hemorrhoids. ConclusionsDoppler-guided hemorrhoidal artery ligation has the advantage of minimally invasive, it is a safe and effective treatment for Ⅱ and Ⅲ degree internal hemorr-hoids or Ⅱ and Ⅲ degree mixed hemorrhoids dominated by internal hemorrhoids.

Clinical efficacy of polidocanol foam sclerotherapy for hemorrhoids: a systematic review and meta-analysis

ObjectiveTo evaluate the clinical efficacy of polidocanol foam sclerotherapy and to establish a reliable evidence base for its application in the treatment of hemorrhoids. MethodsA systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP, and the Chinese Medical Journal Full-text Database for randomized controlled trials (RCTs) published from January 1, 2000 to December 1, 2024. Included patients were assigned to either an intervention group group (treated with polidocanol foam sclerotherapy) or a control group (receiving other interventions). Data from the included studies were pooled and analyzed using a meta-analysis model in Review Manager 5.4 software. The primary outcomes were the clinical cure rate, postoperative recurrence rate, and incidence of postoperative bleeding. The secondary outcomes were the pain visual analogue scale (VAS) score and the incidence of severe postoperative pain. ResultsA total of 12 RCTs involving 1 380 patients with hemorrhoids were included. The pooled results demonstrated that, compared to the control group, the intervention group showed a significantly higher clinical cure rate [RR (95%CI)=1.36 (1.26, 1.47)], as well as lower postoperative recurrence rate [RR (95%CI)=0.43 (0.29, 0.65)] and postoperative bleeding rate [RR (95%CI)=0.75 (0.60, 0.93)]. However, there were no statistically significant differences between the two groups in terms of postoperative pain VAS score [WMD (95%CI) =–0.53 (–1.15, 0.09)] or the incidence of severe postoperative pain [RR (95%CI)=0.81 (0.34, 1.94)]. ConclusionPolidocanol foam sclerotherapy demonstrates superior clinical efficacy in terms of clinical cure rate, postoperative recurrence rate, and postoperative bleeding rate, confirming its effectiveness as a treatment for hemorrhoids.

Relevant Issue of Procedure for Prolapse and Hemorrhoids in Application

康復新對痔病繼發貧血患者術后促愈作用及血紅蛋白的影

目的分析評價康復新對痔病繼發貧血患者術后的治療效果。 方法將2008年1月－2014年10月60例痔病繼發貧血患者及30例普通痔病患者分為3組，每組各30例。治療組為貧血患者，術后加用康復新口服及創面坐浴；對照1組（貧血患者）及對照2組（非貧血患者）術后采取普通換藥。比較3組患者的平均愈合時間，以及第10天和第20天貧血改善率。 結果治療組平均愈合時間為（14.5±0.8）d，對照1組平均愈合時間為（21.0±1.4）d，對照2組平均愈合時間為（18.0±0.6）d，治療組與對照1組和對照2組比較，差異有統計學意義（P＜0.05）。治療組第10天血紅蛋白（Hb）平均改善率為（44.82±19.45）%，第20天Hb平均改善率為（69.32±23.28）%，對照1組第10天Hb平均改善率為（16.27±13.31）%，第20天Hb平均改善率為（31.90±14.69）%，治療組與同時期對照1組比較，差異有統計學意義（P＜0.05）。 結論康復新口服及創面坐浴對痔病繼發貧血患者術后有更好的臨床療效。