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.
目的 探讨嵌顿环状混合痔的手术治疗方法。 方法 回顾性总结我院1998年1月至2002年1月采用小切口外剥内扎硬注术治疗嵌顿环状混合痔30例临床经验。 结果 30例患者手术过程顺利，手术时间平均50 min，平均住院时间10 d，术后并发肛门Ⅰ度水肿4例，术后当天排尿困难1例，经对症治疗后痊愈出院。本组病例术后随访1年均无复发。 结论 该术式能迅速减轻患者痛苦，且疗效满意。
目的总结分段齿形结扎加皮桥整形术治疗环状混合痔的优、缺点。方法将我院2007年1月至2009年12月期间收治的80例环状混合痔患者按入院顺序简单随机分成2组，治疗组采用分段齿形结扎加皮桥整形术治疗，对照组采用传统的外剥内扎术，比较2组的疗效。结果治疗组治愈率为95%(38/40),对照组为90%(36/40)，2组比较差异无统计学意义(Pgt;0.05); 治疗组较对照组的治愈时间明显缩短(Plt;0.05)，术后疼痛、水肿、皮赘残留及肛管狭窄并发症方面更轻(Plt;0.05)。结论分段齿形结扎加皮桥整形术治疗环状混合痔比传统的外剥内扎术有更好的临床实用价值。
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.
目的 探讨痔的病因及其分类，总结痔的诊治经验。方法 回顾性分析2005年7月至2008年9月期间在我院诊治的53例痔患者的临床资料。结果 18例Ⅱ度内痔中11例给予一般治疗，有7例便后仍有痔块脱出; 7例注射治疗均无便后痔块脱出。14例外痔均治愈，其中5例血栓性外痔均行血栓剥离术; 6例单纯结缔组织外痔中4例给予一般治疗，2例手术切除皮赘，瘙痒、潮湿症状改善; 3例单纯炎性外痔给予口服抗生素及一般治疗，疼痛症状缓解。21例Ⅲ、Ⅳ度内痔或混合痔术后均无痔块随排便脱出，其中16例（76.2%）发生肛门水肿，15例（71.4%）肛门疼痛短期临时应用止痛剂后缓解，共有15例（71.4%）患者获得随访，随访1～3年（平均2年），无复发，无肛门狭窄，无控便及精细控便障碍。结论 内、外痔各有其相应的病因及发病机理。应放弃用一种学说或发病机理解释所有“痔”的思维。MilliganMorgan术仍是基层医院治疗Ⅲ、Ⅳ度内痔或混合痔较理想术式，但疼痛和水肿是其不足。
Objective To investigate the clinical curative effect of divided excision and plastic combined with procedure for prolapse and hemorrhoids (PPH) in treatment for circular mixed hemorrhoids. Methods Clinical observation on 120 patients with circular mixed hemorrhoids between May 2007 and May 2008 treated by divided excision and plastic combined with PPH was carried out. Results The mean hospital stay after operation was 7.6 d. The wound healing average time was 11.9 d. The incidence rate of postoperative urinary retention was 5.8% (7/120). Average scores of pain in 3 d after operation: 5.3 points (1-8 points) on day 1, 3.6 points （2-9 points） on day 2, 2.2 points （1-8 points） on day 3. All patients were followed up for 12 months, there were 3 cases of hematochezia， 1 case of prolapse, and 1 case of remained abnormal outgrowth skin; the anus function was normal in all cases without anal stricture or tightening feeling. Conclusions Divided excision and plastic combined with PPH can better treat circular mixed hemorrhoids. This operation can not only completely clear the lesions, but also repair and reconstruct the anus and anal canal, protect its size and function. It is an ideal operation for treatment for circular mixed hemorrhoids.