ObjectiveTo evaluate the safety of shearing fracture ligation combining procedure for prolapse and hemorrhoids （PPH） in treatment for mixed hemorrhoids via a multicenter clinical study. MethodsTwo hundred and fortysix patients with mixed hemorroids were included from four a level of firstclass hospitals, which were averagely divided into shearing fracture ligation combining PPH group, PPH group, and shearing fracture ligation group according to the order of admission. The occurrence status of rectovaginal fistula, urethrorectal fistula, postoperative bleeding, acute urinary retention, anorectal stenosis, and anal incontinence were observed. And the anal function was evaluated by the anorectal pressure measurement. ResultsNo rectovaginal fistula or urethrorectal fistula happened among three groups. No anorectal stenosis happened in the shearing fracture ligation combining PPH group or the PPH group. The score of anorectal stenosis and anal incontinence in these two groups were lower than those in the shearing fracture ligation group (Plt;0.05). The rate of postoperative bleeding in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group (Plt;0.05). There were acute urinary retentions happened among three groups, but without significant differences among them (Pgt;0.05). The anal canal resting pressure after operation was lower than that before operation among three groups (Plt;0.01), which in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group after operation (Plt;0.05). There were no significant differences of the rectum feeling capacity or maximum rectum capacity between the shearing fracture ligation combining PPH group and PPH group before and after operation (Pgt;0.05), but compared with the level before operation in the shearing fracture ligation group, the rectum feeling capacity obviously decreased after operation (Plt;0.05), the maximum rectum capacity obviously increased (Plt;0.05). There were no significant differences of the maxinum anal canal systolic blood pressure between before and after operation in three groups and among three groups (Pgt;0.05). ConclusionsThe operation of shearing fracture ligation combined with PPH can protect the tissue of rectal cushion, remain the normal anatomy structure of anal canal. It has better clinical effect and is much safer than other methods.
ObjectiveTo compare the efficacy and safety of automatic ligation of hemorrhoids (ALH) and procedure for prolapsed hemorrhoids (PPH) in the treatment of elderly patients with hemorrhoids.
MethodsOne hundred and eighty elderly patients with hemorrhoids who were admitted into the First People's Hospital of Jining City from January 2012 to December 2014 were enrolled. According to the operative mode, the patients were divided into ALH group and PPH group, with 90 cases in each group, received ALH and PPH treatment respectively. The postoperative pain, urinary retention, edema, bleeding, infection, anal swelling and anal stenosis were observed in the two groups, and two methods of operation were evaluated in terms of operation time, intraoperative bleeding, postoperative bleeding, postoperative pain, healing time, hospitalization expenses and postoperative complications.
ResultsThe VAS scores of the ALH group in the day 1-3 after operation were lower than that of the PPH group, the difference was statistically significant (P < 0.05); the frequency of the use of analgesics in ALH group was less than that in PPH group (P < 0.01); the amount of blood loss and the healing time of the ALH group were significantly less or shoter than those of the PPH group (P < 0.01); the incidence of postoperative urinary retention in the ALH group was 2.22% (2/90), which was significantly lower than that of the PPH group, 27.78% (25/90), the difference was statistically significant (χ2=23.050, P=0.000); the incidence of perianal edema after operation in the ALH group was 5.56% (5/90), which was significantly lower than that of PPH group of 15.56% (14/90), the difference was statistically significant (χ2=4.766, P=0.029). There was no obvious postoperative bleeding in the ALH group(0/90), while the incidence of postoperative bleeding in the PPH group was 7.78% (7/90), and the difference between the two groups was statistically significant (Fisher's exact test, P=0.007). The efficiency of ALH group was 98.89% (89/90) and the PPH group was 97.78% (88/90), the difference between the two groups was not statistically significant (χ2=0.339, P=0.560). Conciusions There is no significant difference between ALH and PPH in the treatment of elderly patients with hemorrhoids, but ALH has the advantages of less pain, quicker recovery and fewer complications, it is worthy of popularization and application.
Objective To evaluate the safety and efficacy of procedure for prolapse and hemorrhoids （PPH） combined with Shaobei injection in treatment for obstructed defecation syndrome （ODS） caused by rectocele. Methods Seventy-two female patients with rectocele from December 2009 to January 2011 in this hospital were divided into PPH combined with Shaobei injection group （36 cases） and only PPH group （36 cases）. The Longo ODS score was performed on week one，month one，month three，and month six after operation，respectively；pain was evaluated， complications such as urine retention，postoperative bleeding，and anal function were observed；hospital stay and recovery work time were recorded in two groups. Results All patients were followed up for 6 months，there were no significant differences in complications，hospital stay，and the Longo ODS score on week one and month one after operation between two groups （P＞0.05）. But the Longo ODS score of the PPH combined with Shaobei injection group on month three and month six after operation were significantly lower than those of the only PPH group （P＜0.05）. Conclusion PPH combined with Shaobei injection has a better efficacy as compared with only PPH，and at least as safe as only PPH.
ObjectiveTo investigate the curative effect of C-shaped mucosal resection and anastomosis above the dentate line in the treatment of mixed hemorrhoids and its effect on anal function. MethodsA total of 78 patients with degree Ⅳ mixed hemorrhoids treated in Nanjing Liuhe District People’s Hospital from June 2015 to February 2018 were retrospectively collected. The patients were divided into control group (n=39) and observation group (n=39) according to treatment methods. Patients of the control group received traditional procedure for prolapse and hemorrhoids operation, while patients of the observation group received C-shaped mucosal resection and anastomosis above the dentate line. The perioperative indexes (operation time, intraoperative blood loss, hospital stay, etc.), subjective function evaluation indexes (Wexner constipation score, Kirwan grade, etc.), clinical efficacy and recurrence rate were compared between the two groups. The random walking model was used to evaluate the clinical curative effect. ResultsThe intraoperative blood loss [(27.9±3.4) mL vs. (43.2±5.2) mL, P<0.001], 24 h visual analogue scale score [(4.2±1.5) points vs. (5.6±1.5) points, P<0.001], duration of first defecation pain [(22.1±3.2) min vs. (34.2±5.0) min, P<0.001], the time of carrying blood [(4.1±0.4) d vs. (5.7±0.6) d, P<0.001], and the time of edema [(3.2±0.6) d vs. (4.7±0.9) d, P<0.001] in the observation group were shorter (lower) than those in the control group. The difference between pre-and post-operation of Wexner constipation score [(13.2±2.4) points vs. (11.7±2.1) points, P=0.004], resting pressure [(23.1±4.9) mmHg vs. (17.8±3.4) mmHg, P<0.001] and maximum squeeze pressure [(33.5±7.3) mmHg vs. (23.1±5.6) mmHg, P<0.001] in the observation group were significantly higher than those in the control group. There was a long-term correlation between changes in random fluctuating power rate values of Wexner constipation score, Kirwan grade, rectoanal inhibitory reflex positive rate, resting pressure, maximum squeeze pressure and the surgical procedure received by the patient of the two groups. The total effective rate [97.4% (38/39) vs. 66.7% (26/39)] and non-recurrence rate [92.3% (36/39) vs. 76.9% (29/39)] in the observation group were higher than those in the control group, while there was no significant difference in the incidence of total complications between the two groups [5.1% (2/39) vs. 12.8% (5/39), P=0.235)]. ConclusionCompared with PPH, C-shaped mucosal resection and anastomosis above the dentate line for the treatment of degree Ⅳ mixed hemorrhoids can improve the therapeutic effect, reduce postoperative recurrence, maintain anal function and facilitate the recovery of patients.
Objective To compare the postoperative anorectal pressure after procedure for prolapse and hemorrhoids
(PPH) and Milligan-Morgan hemorrhoidectomy (MMH) in treatment of patients with mixed hemorrhoid of Ⅲ-degree.
Methods In total of 112 patients with mixed hemorrhoid of Ⅲ-degree who underwent PPH (n=60) or MMH (n=52) in The First Affiliated Hospital of Xinjiang Medical University between March 2014 to March 2015 were prospectively enrolled, the type of surgery was according to patients’ individual choice. In 6 months after operation, all patients under-went the examination of anorectal manometry which including rectal anal inhibitory reflex, rectal resting pressure, anal resting pressure, maximal anal contractive pressure, and anal canal length of high pressure belt.
Results In 6 months after
operation, the positive rate of rectal anal inhibitory reflex 〔88.3% (53/60) vs. 61.5% (32/52)〕 , anal resting pressure 〔(56.42±
2.25) mm Hg vs. (46.31±2.58) mm Hg〕, and anal canal length of high pressure belt 〔(3.35±0.12) cm vs. (2.29±0.23) cm〕 of PPH group were all significantly higher than those of MMH group (P＜0.05), but there was no statistical significance between PPH group and MMH group in rectal resting pressure 〔(5.51±1.26) mm Hg vs. (5.39±1.85) mm Hg〕 and maximal anal contractive pressure 〔(156.64±9.78) mm Hg vs. (155.32±8.53) mm Hg〕, P>0.05.
Conclusion PPH and MMH are all effective to treat mixed hemorrhoids of Ⅲ-degree, but PPH is more positive in protection of anal function.
Objective To compare the clinical effect of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of hemorrhoid in Ⅲ-Ⅳ degree.
Methods Clinical data of 80 cases of hemorrhoid in Ⅲ-Ⅳ degree who treated in The First Affiliated Hospital of Harbin Medical University from May 2015 to July 2015 were retrospectively collected. All the 80 cases were divided into TST group (n=40) and PPH group (n=40) according to the surgical types. The comparison of the clinical effect of 2 groups was performed.
Results The operative time, hospital stay, intraoperative blood loss, anal fall bilge feeling score, postoperative pain score at 3 time points, and the incidence of anal secretions of TST group were lower or shorter than those corresponding indexes of PPH group (P<0.05). But there was no significant difference in cure rate, the incidence of urinary retention, the incidence of anal stenosis, the incidence of intractable pain, and satisfaction situation between the 2 groups (P>0.05). All of the cases were followed up for 3 months, during the follow-up period, no one suffered from rectal vaginal fistula, fecal incontinence, and recurrence.
Conclusion TST and PPH both have satisfactory effect in treatment of hemorrhoid in Ⅲ-Ⅳ degree, but TST has advan-
tages of less blood loss, shorter operative time, rapid postoperative recovery, and less pain.
摘要:目的:觀察超短波治療對痔術后創面愈合的影響。方法:將100例混合痔術后患者分為治療組和對照組各40例,治療組于術后24小時給予超短波治療和復方紫草油紗條換藥,對照組僅給以復方紫草油紗條換藥,觀察兩組創面愈合時間和創面上皮生長速度。結果:治療組較對照組創面愈合時間更短(Plt;0.01),創面上皮生長速度更快(Plt;0.01)。結論〗:超短波治療能夠加速痔術后創面愈合時間,減少痛苦,療效確切安全。Abstract: Objective: To observe the clinical efficacy of ultrashort wave on the healing of wound after operation for hemorrhoids. Methods: One hundred cases of disease subjected to operation were divided into the treatment group (50 cases) and the control group (50 cases).The treatment group had been given ultrashort wave 24 hours after operation and Fufangzicaoyousa ointment gauze. The control group had been give Fufangzicaoyousa ointment gauze. Results: The results showed that the woundhealing time was much shorter in the treatment group than in the control group (Plt;0.01), the epidermis growth was much faster in the treatment group than in he control group (Plt;0.01). Conclusion: Ultrashort wave can promote the healing of wound after the operation for hemorrhoids and relieve pain, and it can be externally used safely.
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.
Objective
To investigate the clinical efficacy of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids.
Methods
Seventy patients with Ⅲ-Ⅳ internal henmorrhoids and mixed hemorrhoids who were admitted into Jiangsu Provincial Hospital of Traditional Chinese Medicine form June 2015 to June 2016 were enrolled. The patients were randomly divided into two groups: the combined operativ group and control group. The combined operativ group in which 35 cases were treated by pouched suture plus external dissection and internal ligation, and the control group in which 35 cases were treated by external dissection and internal ligation. The wound healing time, clinical curative effect, hospital stay, the operative time and postoperative complications (postoperative pain, edema, postoperative bleeding volume, urination difficulties, residual skin tag, anorectal stenosis) between two groups were compared.
Results
No significant difference were found in the clinical curative effect, the operative time and anorectal stenosis in two groups (P>0.05). The visual analogue scale (VAS) scores and the edema scores of the combined operativ group on the first day, the third day, and the fifth day after operation were lower than those of control group, the difference was statistically significant (P<0.05), while there were no statistically significant on the seventh day after operation in two groups (P>0.05) . The wound healing time, hospital stay, postoperative bleeding volume, urination difficulties, and residual skin tag in the combined operativ group were significantly shorter or lower than those in the control group (P<0.05).
Conclusion
Pouched suture plus external dissection and internal ligation has the advantages of less pain, fewer complications and quicker recovery, it also meets the modern concept of minimally invasive, so it is worthy of popularization and application.
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.
