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Clinical Study of Curing Rectocele by Divided Plastic Tightening and Constricting Operation

【摘要】目的 探討分段整形提縮注射術治療脫肛痔的臨床療效。方法 175例重度環狀痔, 沿肛緣弧形切除結締組織外痔以整形肛門, 再于結扎痔核基底及其上端黏膜下層注射消痔靈注射液,并進行療效觀察。結果 術后肛周水腫(72 h)、疼痛(24及72 h)明顯減少； 術后4周臨床治愈145例,好轉23例,總有效率為96.0%； 所有患者均隨訪3~6個月，未見復發。結論 選擇分段整形提縮注射術既比較徹底地去除了痔核使之不易復發，又整形了肛門，保護其大小和功能, 該術式可成為治療脫肛痔的較理想術式。

Clinical Observation of MilliganMorgan Operation Combined with Injection and Fenestration for Treatment of Circular Mixed Hemorrhoid

目的比較外剝內扎（注射）加開窗治療環狀混合痔和傳統外剝內扎法治療環狀混合痔的臨床療效。方法80例環狀混合痔患者分別接受外剝內扎（注射）加開窗治療和傳統外剝內扎法治療，對兩種術式的療效進行比較。結果2組患者術后均未發生肛門失禁癥狀，肛門功能的差異無統計學意義（Pgt;0.05），而治療組患者肛門狹窄、肛門水腫和疼痛明顯輕于對照組（Plt;0.05），尿潴留、切口愈合時間以及復發也明顯少于對照組（Plt;0.05）。結論外剝內扎（注射）加開窗術是環狀混合痔的較好治療方案。

Segmenting Jugged Ligation Combined with Skin Bridge Plastic Operation In Treatment for Circumferential Mixed Hemorrhoids

目的總結分段齒形結扎加皮橋整形術治療環狀混合痔的優、缺點。方法將我院2007年1月至2009年12月期間收治的80例環狀混合痔患者按入院順序簡單隨機分成2組，治療組采用分段齒形結扎加皮橋整形術治療，對照組采用傳統的外剝內扎術，比較2組的療效。結果治療組治愈率為95%(38/40),對照組為90%(36/40)，2組比較差異無統計學意義(Pgt;0.05); 治療組較對照組的治愈時間明顯縮短(Plt;0.05)，術后疼痛、水腫、皮贅殘留及肛管狹窄并發癥方面更輕(Plt;0.05)。結論分段齒形結扎加皮橋整形術治療環狀混合痔比傳統的外剝內扎術有更好的臨床實用價值。

Metronidazole for Treatign the Post Hemorrhoidectomy Pain: A Systematic Review

Objectives　To evaluate the effect of metrinidazole treatment after conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Methods　We searched the Cochrane Library (Issue 1 2009), PubMed (1966 to March 2009), EMbase (1974 to March 2009), SCI (1974 to March 2009), CBM (1978 to March 2009), CNKI (1994 to March 2009), and VIP (1989 to March 2009) to identify randomized controlled trials or quasi- randomize controlled trials of metronidazole versus placebo for treating post hemorrhoidectomy pain. We evaluated the quality of the included studies by using the Handbook 4.2.6 recommend standards and analyzed data using the Cochrane Collaboration’s RevMan 4.2.10. Results　We included seven randomized controlled trials or quais-randomized controlled trials (n=553). Meta-analyses showed that there were statistical differences between metronidazole and placebo in pain after hemorrhoidectomy and the use of an additional dose of analgesia. Conclusions　The current evidence shows that metronidazole relieves the pain after conventional hemorrhoidectomy and reduces the additional used of analgesics. Further high quality, large sample randomized controlled trials should be carried out.

音樂療法對混合痔外剝內扎術后疼痛的影響

目的探討音樂療法對混合痔外剝內扎術后患者疼痛的影響。 方法2012年10月－2013年3月采用隨機數字表法將120例混合痔外剝內扎術后患者隨機分成兩組，每組60例。對照組只接受常規護理；試驗組除給予常規護理外，加以音樂療法，2次/d（晨起和睡前），45 min/次。于術后24 h及48 h，采用視覺模擬評分法（VAS）評估兩組患者的疼痛程度并進行比較。 結果術后24 h及48 h，試驗組VAS評分均明顯低于對照組，差異有統計學意義（P＜0.05）。 結論音樂療法能降低混合痔外剝內扎術后患者對疼痛的敏感性，緩解其疼痛，值得臨床推廣。

Progress in pathogenesis of hemorrhoids: research of molecular biology

ObjectiveTo understand the progress of molecular biology research on the pathogenesis of hemorrhoids. MethodThe literatures relevant to reseaches on the molecular biology of hemorrhoid pathogenesis in recent years had been reviewed. ResultsThe generally accepted theories of hemorrhoids included anal cushion downward movement theory, varicose vein theory, and vascular proliferation theory. The molecular biological studies related to the theory of anal cushion downward movement found that the increased expression of matrix metalloproteinase-9 and the abnormal expression of smooth muscle actin could damage the supporting tissue of anal cushion, causing the downward movement and prolapse of anal cushion, and then formed hemorrhoids; The molecular biology researches related to varicose vein theory found that the increase of nitric oxide synthase and transient receptor potential vanilloid 1 could promote the production of nitric oxide, causing varicose veins, and then leaded to the pathogenesis of hemorrhoids; The molecular biology researches related to vascular proliferation theory found that the low expressions of miR-412-5p and miR-4729, and the overexpressions of vascular endothelial growth factor and fibroblast growth factor were related to the vascular proliferation of hemorrhoids. In addition, the secondary inflammatory reaction after the onset of hemorrhoids also played an important role in the occurrence and development of hemorrhoids. ConclusionsThe occurrence and development of hemorrhoids is the result of the intersection and interaction of various mechanisms such as anal cushion downward movement, varicose veins, vascular proliferation, and secondary inflammatory reaction. The molecular biology research on the pathogenesis of hemorrhoids is helpful to better explain the occurrence of hemorrhoids from a microcosmic perspective, and lay a foundation for further exploring the etiology of hemorrhoids.

Evaluation of Hemorrhoids Modernized Treatment

Modified Technique of the External Dissection and Internal Ligation for Mixed Hemorrhoid

目的 探討混合痔切除外剝內扎術術式的改進方法。方法 應用該改進術式共治療混合痔1126例，切除混合痔2489個，其中一次切除痔在3個以上乃至近環行切除僅留1 cm皮橋者450例，混合痔1461個。結果 術后創面滲血、疼痛及愈合時間均明顯優于傳統混合痔外剝內扎術； 術后排便通暢，隨訪6個月，無一例出現肛門狹窄； 創面愈合后疤痕較輕，外形美觀，能最大程度恢復原肛門解剖結構和生理功能。結論 該術式方法簡單、實用，克服了傳統手術的不足。

Effectiveness of PPH in Treatment for Constipation Caused by Rectocele in 104 Cases

目的　觀察吻合器痔上黏膜環形切除釘合術（PPH）治療直腸前突所致便秘的臨床療效。方法　回顧性分析我科2008年1月至2012年1月期間經PPH治療的104例女性直腸前突致便秘患者的手術經過及術后療效。結果　本組104例均手術順利，手術時間13～35min，平均21min；住院時間3～7d，平均4.5d；無直腸陰道瘺、肛周膿腫、肛門狹窄等并發癥發生。術后2周均常規行肛門指檢，3例局部輕度炎癥，給予抗炎對癥治療后癥狀消失。5例吻合口局部吻合釘未完全脫落，給予取出后不適癥狀消失。術后隨訪1～5年（平均3年），隨訪率為97.12%（101/104），臨床癥狀完全消失99例，治愈率為95.19%；癥狀好轉5例，該5例行排糞造影檢查，直腸前突均明顯減輕，且便秘癥狀明顯緩解。結論　PPH治療女性直腸前突所致便秘安全、有效，便秘癥狀緩解明顯，是一種適合臨床應用的手術方式。

Clinical Observation on Two Kinds of Surgical Treatments for Severe Mixed Hemorrhoid Ring

目的:探討吻合器痔上黏膜環切吻合術(PPH術)+外痔切除和單純外剝內扎術治療重度環狀混合痔的臨床效果。方法:對收治的48例III,IV度環狀混合痔患者隨機分為2組,分別采用PPH術+外痔切除術和單純外剝內扎術予以治療的療效進行比較。結果:通過對手術時間、術中出血、疼痛程度、住院時間、患者滿意度等進行比較觀察,表明PPH術+外痔切除具有明顯優勢。結論:PPH術+外痔切除術仍能保持單純PPH優勢,克服其不足之處,較傳統外剝內扎術治療重度環狀混合痔有明顯的優勢。