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。
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 探討嵌頓環狀混合痔的手術治療方法。 方法 回顧性總結我院1998年1月至2002年1月采用小切口外剝內扎硬注術治療嵌頓環狀混合痔30例臨床經驗。 結果 30例患者手術過程順利，手術時間平均50 min，平均住院時間10 d，術后并發肛門Ⅰ度水腫4例，術后當天排尿困難1例，經對癥治療后痊愈出院。本組病例術后隨訪1年均無復發。 結論 該術式能迅速減輕患者痛苦，且療效滿意。
目的 探討痔的病因及其分類，總結痔的診治經驗。方法 回顧性分析2005年7月至2008年9月期間在我院診治的53例痔患者的臨床資料。結果 18例Ⅱ度內痔中11例給予一般治療，有7例便后仍有痔塊脫出; 7例注射治療均無便后痔塊脫出。14例外痔均治愈，其中5例血栓性外痔均行血栓剝離術; 6例單純結締組織外痔中4例給予一般治療，2例手術切除皮贅，瘙癢、潮濕癥狀改善; 3例單純炎性外痔給予口服抗生素及一般治療，疼痛癥狀緩解。21例Ⅲ、Ⅳ度內痔或混合痔術后均無痔塊隨排便脫出，其中16例（76.2%）發生肛門水腫，15例（71.4%）肛門疼痛短期臨時應用止痛劑后緩解，共有15例（71.4%）患者獲得隨訪，隨訪1～3年（平均2年），無復發，無肛門狹窄，無控便及精細控便障礙。結論 內、外痔各有其相應的病因及發病機理。應放棄用一種學說或發病機理解釋所有“痔”的思維。MilliganMorgan術仍是基層醫院治療Ⅲ、Ⅳ度內痔或混合痔較理想術式，但疼痛和水腫是其不足。
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 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.
Objective To summarize the clinical effect and the key part of operation of procedure for prolapse and hemorrhoids （PPH） in treatment for severe mixed hemorrhoids or circular hemorrhoids. Method The data of 183 patients with severe mixed hemorrhoids or circular hemorrhoids underwent PPH in this hospital from August 2006 to November 2012 were analyzed retrospectively. Results The operation time was （28.5±3.1） min. The operations were successfully completed at one-stage in all the patients. The average hospital stay was 5.2 d. No postoperative bleeding， fecal incontinence， and infection happened. No recurrence and complications such as postoperative rebleeding，anal stenosis， fecal incontinence， etc were found during 1 month to 3 years of follow-up with an average 26 months. Conclusions PPH as a minimally invasive operation， every detail of it should be well performed in order to improve the clinical treatment effect and reduce complications of the patients with severe mixed hemorrhoids or circular hemorrhoids.