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。
ObjectiveTo observe the efficacy of "Fuchuang Xunxi Formula" at different concentrations on patients after mixed hemorrhoidectomy. MethodsTwo hundred and ten patients having undergone mixed hemorrhoidectomy between October and November 2013 were randomized into seven groups, with 30 patients in each group. Group A was treated with 6% "Fuchuang Xunxi Formula"; Group B was treated with 6% "Zhiji Fumigation Formula"; Group C was treated with 4% "Fuchuang Xunxi Formula"; Group D was treated with 4% "Zhiji Fumigation Formula"; Group E was treated with 3% "Fuchuang Xunxi Formula"; Group F was treated with 3% "Zhiji Fumigation Formula"; And Group G was treated with branch water. Each group was fumigated at 45℃ for five minutes, then hip bath at 40℃ for five minutes with a course of 10 days. The curative effect of pain of wound, edema, effusion, urinary disturbance were observed. ResultsThe therapeutic effect in group C was the best (P<0.05), and the relief of postoperative complications (pain, edema, effusion) was better than the other groups (P<0.05). ConclusionTreatment with 4% "Fuchuang Xunxi Formula" for postoperative complications is the most effective.
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.
目的 比较改良外剥内扎术与传统外剥内扎术（Milligan-Morgan手术，MM手术）治疗混合痔的疗效。方法 我院2004年3月至2007年11月期间收治了96例混合痔患者，按抽签法随机均分成了改良外剥内扎术组（改良组）和传统外剥内扎术组（传统组）2组，对2组患者的疗效和并发症进行比较。结果 改良组42例患者治愈，6例好转； 传统组30例患者治愈，16例好转，2例未愈，2组比较差异有统计学意义（Plt;0.05）。改良组患者术中出血量〔(15.4±2.8) ml〕少于传统组〔(25.6±3.3) ml〕，Plt;0.05； 手术时间〔(40.2±5.3) min〕也短于传统组〔(70.5±4.8) min〕，Plt;0.05。改良组患者术后疼痛轻于传统组，并发症也少于传统组，差异均有统计学意义（Plt;0.05）。改良组患者住院时间〔(12.45±2.25) d〕明显短于传统组患者〔(18.69±2.72) d〕，Plt;0.05。2组患者随访20～27个月（平均2年），仅传统组1例复发。结论 改良外剥内扎术的疗效好于传统外剥内扎术。
目的比较外剥内扎（注射）加开窗治疗环状混合痔和传统外剥内扎法治疗环状混合痔的临床疗效。方法80例环状混合痔患者分别接受外剥内扎（注射）加开窗治疗和传统外剥内扎法治疗，对两种术式的疗效进行比较。结果2组患者术后均未发生肛门失禁症状，肛门功能的差异无统计学意义（Pgt;0.05），而治疗组患者肛门狭窄、肛门水肿和疼痛明显轻于对照组（Plt;0.05），尿潴留、切口愈合时间以及复发也明显少于对照组（Plt;0.05）。结论外剥内扎（注射）加开窗术是环状混合痔的较好治疗方案。
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.
ObjectiveTo 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.MethodsFrom 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.ResultsWhether 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).ConclusionsCombined 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.
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.