目的 比较吻合器痔上黏膜环切术(PPH)与传统痔切除术(Milligan-Morgan，MM)治疗混合痔的临床疗效。方法 200例混合痔患者中行PPH和MM治疗各100例，比较2组患者的疗效及并发症。结果 PPH在疗效及术后并发症发生方面与MM组比较，差异均无统计学意义（P＞0.05）。结论 在治疗混合痔方面PPH不优于MM。
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.
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.