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 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。
目的 探討吻合器痔上黏膜環形切除釘合術(ＰＰＨ)手術操作規范。 方法 對《PPH暫行規范》（修訂）“術中操作” 中的兩個關鍵性步驟進行分析、討論。結果 《PPH暫行規范》（修訂）中的手術操作指導存在不便操作、相互矛盾、難以取得理想效果等問題。在PPH操作中，適度牽拉后置入肛管擴張器以充分顯露痔上黏膜，原位6～8針均勻而恰到好處的黏膜下層雙荷包縫合，以痔核上緣作為荷包縫合的主要定位依據，荷包縫好松開牽拉鉗后用食指或無創傷鉗裹紗布將痔核及脫出的肛管組織盡量往直腸內推送復位，以及收緊吻合器時持續用力牽引荷包線，旋緊吻合器直至最緊狀態時才予以擊發是保證PPH手術順利進行和增加切割組織寬度的重要操作技巧。結論 對《PPH暫行規范》（修訂）的探討得出的操作技巧宜在規范中予以推薦和強調。
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.
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 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 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.
目的總結分段齒形結扎加皮橋整形術治療環狀混合痔的優、缺點。方法將我院2007年1月至2009年12月期間收治的80例環狀混合痔患者按入院順序簡單隨機分成2組，治療組采用分段齒形結扎加皮橋整形術治療，對照組采用傳統的外剝內扎術，比較2組的療效。結果治療組治愈率為95%(38/40),對照組為90%(36/40)，2組比較差異無統計學意義(Pgt;0.05); 治療組較對照組的治愈時間明顯縮短(Plt;0.05)，術后疼痛、水腫、皮贅殘留及肛管狹窄并發癥方面更輕(Plt;0.05)。結論分段齒形結扎加皮橋整形術治療環狀混合痔比傳統的外剝內扎術有更好的臨床實用價值。