Objective To observe the effect of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviated as combined therapy) in the treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure.Methods From January 2016 to June 2018, the patients with grade Ⅲ–Ⅳ mixed hemorrhoids who underwent surgical treatment in this hospital were selected for the prospective study, including 100 patients with high pressure (>70 mm Hg, 1 mm Hg=0.133 kPa) and 100 patients with low pressure (≤70 mm Hg), then which were divided into an experimental group and a control group according to the random number table method (with 50 cases in each group). The patients in the control group underwent the PPH and in the experimental group underwent the combined therapy. The therapeutic effect and perioperative indicators were observed in each group, Visual Analogue Scale (VAS) was used to evaluate the degree of pain before and after the operation, the incidence of complications and the recurrence rate of symptoms were observed, the factors influencing the therapeutic effect of combined therapy were analyzed.Results Whether for the patients with high or low rectal and anal canal resting pressure, although the operation time of the experimental group was significantly longer than that of the control group (t=8.996, P<0.001; t=8.927, P<0.001), the total effective rate was higher (χ²=7.294, P=0.007; χ²=6.775, P=0.009), the length of stay in hospital was shorter (t=11.922, P<0.001; t=11.442, P<0.001), the hospital expenses decreased significantly (t=2.226, P=0.028; t=2.562, P=0.012), the VAS score at 24 h and 72 h after operation were lower (24 h: t=12.659, P<0.001; t=12.191, P<0.001; 72 h: t=9.920, P<0.001; t=9.901, P<0.001), the incidence of postoperative complications was lower (χ²=7.484, P=0.006; χ²=11.416, P=0.001) in the experimental group as compared with the control group; there was no significant difference between the two groups (χ²=1.042, P=0.307; χ²=0.211, P=0.646). The course of disease and the grade of internal hemorrhoids were the independent factors influencing the marked efficiency of combined therapy (χ²=7.417, P=0.009; χ²=4.286, P=0.017).Conclusions Combined therapy is effective in treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure, it could accelerate recovery of patients and relieve pain. It should be paid attention to patients with long course of disease and severe degree of internal hemorrhoids.

Citation： ZHANG Huichang, XIONG Qiuhua, LUO Xiuqiong. Observation on effect of PPH combined with partial internal anal sphincterotomy in treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(4): 454-459. doi: 10.7507/1007-9424.201907071 Copy

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