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 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.
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 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 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。
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.
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。