目的 對痔切除吻合器痔上黏膜環切術（PPH）與傳統手術在治療混合痔環狀脫垂或內痔環狀脫垂的療效進行比較。方法 回顧性分析2002年1月至2004年9月西苑醫院收治的832例經內鏡確診為內痔及混合痔患者的臨床資料。結果 PPH組： 混合痔247例，治愈228例（92.3%），顯效19例（7.7%）; 內痔168例均治愈（100%）； 術后發生大出血2例（0.5%），住院時間3.1~6.3 d，無一例創面感染。傳統手術組： 混合痔229例中治愈215例（93.9%），顯效14例（6.1%）; 內痔188例中治愈175例（93.1%），顯效13例（6.9%）； 術后發生出血3例，肛管狹窄12例，并發癥發生率為3.6%，住院時間26.2~27.1 d。結論 對痔的環形脫垂，采用PPH手術并與外痔切除或外剝內扎方法相結合，具有手術操作簡單、安全、術后疼痛輕、恢復快等特點，優于傳統的外剝內扎手術。
目的 比較吻合器痔上黏膜環切術(PPH)與傳統痔切除術(Milligan-Morgan，MM)治療混合痔的臨床療效。方法 200例混合痔患者中行PPH和MM治療各100例，比較2組患者的療效及并發癥。結果 PPH在療效及術后并發癥發生方面與MM組比較，差異均無統計學意義（P＞0.05）。結論 在治療混合痔方面PPH不優于MM。
目的探討痔切除吻合器痔上粘膜環切術（PPH）的臨床應用價值。方法采用33 mm痔切除吻合器痔上粘膜切除術對嚴重脫垂性痔30例進行治療。結果全組病例平均手術時間10分鐘，術后住院時間1～3天，脫出痔塊均回縮，切除直腸粘膜完整率達98%，術后90%的患者無肛門疼痛，隨訪3個月，28例滿意，2例基本滿意。結論采用痔切除吻合器痔上粘膜環切術治療嚴重脫垂性痔是一種新技術，其手術操作簡單，具有安全、有效、手術時間短、術后疼痛輕、恢復快等特點，有望替代傳統的治療方法。
Objectives To evaluate the effect of metrinidazole treatment after conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Methods We searched the Cochrane Library (Issue 1 2009), PubMed (1966 to March 2009), EMbase (1974 to March 2009), SCI (1974 to March 2009), CBM (1978 to March 2009), CNKI (1994 to March 2009), and VIP (1989 to March 2009) to identify randomized controlled trials or quasi- randomize controlled trials of metronidazole versus placebo for treating post hemorrhoidectomy pain. We evaluated the quality of the included studies by using the Handbook 4.2.6 recommend standards and analyzed data using the Cochrane Collaboration’s RevMan 4.2.10. Results We included seven randomized controlled trials or quais-randomized controlled trials (n=553). Meta-analyses showed that there were statistical differences between metronidazole and placebo in pain after hemorrhoidectomy and the use of an additional dose of analgesia. Conclusions The current evidence shows that metronidazole relieves the pain after conventional hemorrhoidectomy and reduces the additional used of analgesics. Further high quality, large sample randomized controlled trials should be carried out.
目的:探討吻合器痔上黏膜環切吻合術(PPH術)+外痔切除和單純外剝內扎術治療重度環狀混合痔的臨床效果。方法:對收治的48例III,IV度環狀混合痔患者隨機分為2組,分別采用PPH術+外痔切除術和單純外剝內扎術予以治療的療效進行比較。結果:通過對手術時間、術中出血、疼痛程度、住院時間、患者滿意度等進行比較觀察,表明PPH術+外痔切除具有明顯優勢。結論:PPH術+外痔切除術仍能保持單純PPH優勢,克服其不足之處,較傳統外剝內扎術治療重度環狀混合痔有明顯的優勢。
ObjectiveTo explore the analgesic effect of local infiltration anesthesia with liposome bupivacaine (LB) injection after Milligan-Morgan hemorrhoidectomy through a multicenter, double-blind, randomized controlled study. MethodsA prospective study was conducted on 240 patients with mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou Hospital for Largeintestinal and Anal Diseases, and Puyang People’s Hospital between December 2023 and June 2024. Patients were randomly divided into an observation group (receiving LB injection) and a control group (receiving methylene blue injection) using a random number table. Postoperative outcomes including anal pain scores, insomnia scores, postoperative wound edema scores, urination, time to first defecation, pain during first defecation, perianal sensory recovery time, hospital stay, need for additional analgesic medication, and postoperative complications were compared between the two groups. ResultsAmong 240 patients, 238 completed the study and were included in the analysis, with 119 patients in the observation group and 119 in the control group. ① There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). ② Postoperative anal pain scores at 6 h, 12 h, 24 h, 48 h, 72 h, and 5 d were lower in the observation group than that in the control group (P<0.05). ③ Postoperative insomnia scores on days 1, 2, 3, and 5 were lower in the observation group compared with the control group (P<0.05). ④ Postoperative edema scores on days 3, 5, and 7 were lower in the observation group than that in the control group (P<0.001). ⑤ The observation group showed superior outcomes compared to the control group in the following parameters: postoperative 24 h urination score [0 vs. 0, Z=–2.528, P=0.011], time to first defecation [2 d vs. 2 d, Z=–2.638, P=0.008], pain score at first defecation [3 vs. 5, Z=–9.846, P<0.001], time to recovery of perianal sensation [2 d vs. 1 d, Z=–4.977, P<0.001], hospital stay [6 d vs. 11 d, Z=–12.170, P<0.001], supplemental analgesic medication need at 7 d postoperation [20.2% (24/119) vs. 80.7% (96/119), χ2 = 87.132, P<0.001]. No statistically significant differences were observed between the two groups in the incidence of complications such as: postoperative nausea [6.7% (8/119) vs. 8.4% (10/119), χ2 = 0.240, P=0.624], vomiting [5.0% (6/119) vs. 7.6% (9/119), χ2 = 0.640, P=0.424], dizziness [1.7% (2/119) vs. 4.2% (5/119), χ2=1.325, P=0.250]. ConclusionLocal infiltration anesthesia with LB after Milligan-Morgan hemorrhoidectomy significantly reduces postoperative pain, insomnia, and edema, shortens hospital stays, and accelerates postoperative recovery.