目的 探讨吻合器痔上黏膜环形切除术（PPH）治疗老年人(gt;65岁)重度痔的临床疗效。 方法 采用PPH治疗21例老年人重度痔，其中Ⅲ度痔6例，Ⅳ度痔10例，嵌顿混合痔5例，对术后疗效及并发症的情况进行分析。结果 单纯PPH手术4例（19.0%）,其余17例（81.0%）均行PPH结合其他手术。平均住院时间8 d，平均手术时间21.4 min。术后76.2%的患者痔核完全回缩，水肿消退。手术当天28.6%的患者疼痛需止痛处理。术后并发症的发生以下腹部酸胀不适（57.1%）、尿潴留（28.6%）发生多见。平均随访21.3周，无肛门狭窄、大便失禁发生，无一例复发，便血5例（23.8%），均为便后少量出血。结论 PPH是适用于老年重度痔的理想术式。
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.
目的 对痔切除吻合器痔上黏膜环切术（PPH）与传统手术在治疗混合痔环状脱垂或内痔环状脱垂的疗效进行比较。方法 回顾性分析2002年1月至2004年9月西苑医院收治的832例经内镜确诊为内痔及混合痔患者的临床资料。结果 PPH组： 混合痔247例，治愈228例（92.3%），显效19例（7.7%）; 内痔168例均治愈（100%）； 术后发生大出血2例（0.5%），住院时间3.1~6.3 d，无一例创面感染。传统手术组： 混合痔229例中治愈215例（93.9%），显效14例（6.1%）; 内痔188例中治愈175例（93.1%），显效13例（6.9%）； 术后发生出血3例，肛管狭窄12例，并发症发生率为3.6%，住院时间26.2~27.1 d。结论 对痔的环形脱垂，采用PPH手术并与外痔切除或外剥内扎方法相结合，具有手术操作简单、安全、术后疼痛轻、恢复快等特点，优于传统的外剥内扎手术。
目的比较外剥内扎（注射）加开窗治疗环状混合痔和传统外剥内扎法治疗环状混合痔的临床疗效。方法80例环状混合痔患者分别接受外剥内扎（注射）加开窗治疗和传统外剥内扎法治疗，对两种术式的疗效进行比较。结果2组患者术后均未发生肛门失禁症状，肛门功能的差异无统计学意义（Pgt;0.05），而治疗组患者肛门狭窄、肛门水肿和疼痛明显轻于对照组（Plt;0.05），尿潴留、切口愈合时间以及复发也明显少于对照组（Plt;0.05）。结论外剥内扎（注射）加开窗术是环状混合痔的较好治疗方案。
ObjectiveTo explore the effects of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviation: PPH+sphincterotomy) on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids.MethodsEighty-five patients with severe mixed hemorrhoids admitted to this hospital from February 2017 to February 2018 were selected as the study subjects, then they were divided into a PPH group (n=42) and PPH+sphincterotomy group (n=43) according to the different treatment methods. The patient in the PPH group was treated with the PPH, while in the PPH+sphincterotomy group was treated with the partial internal anal sphincterotomy on the basis of the PPH group. The clinical efficacy, degree of pain, edema of wound margin, anal function, and the recurrence rate of symptoms were observed in two groups.Results① There were no significant differences in the baseline data such as the gender, age, course of disease, grading of internal hemorrhoids, and symptoms between the two groups (P>0.05). ② The total effective rate of the PPH+sphincterotomy group was significantly higher than that of the PPH group [100% (43/43) versus 90.48% (38/42), χ2=4.297, P=0.038]. ③ The VAS score of the PPH+sphincterotomy group was significantly lower than that of the PPH group on the 3rd and 7th day after the treatment (P<0.05), the VAS score of each group at the 3rd or 7th day after the treatment was significantly lower than that before the treatment (P<0.05), and it was significantly lower on the 7th day than that on the 3rd day after the treatment (P<0.05). ④ The postoperative wound margin edema in the PPH group was more serious than that in PPH+sphincterotomy group (χ2=20.237, P<0.001), and the score in the PPH group was significantly higher than that in the PPH+sphincterotomy group (t=13.514, P<0.001). ⑤ The resting pressure of anal canal after the treatment was significantly lower than that before treatment (P<0.05), and the diastolic pressure of anal canal after the treatment was significantly higher than that before the treatment (P<0.05) in the two groups. The resting pressure of anal canal in the PPH+sphincterotomy group was significantly lower than that in the PPH group and the diastolic pressure of anal canal was significantly higher than that in the PPH group (P<0.05) after the treatment. ⑥ In addition, the total recurrence rate of symptoms at 1 year in the PPH+sphincterotomy group was significantly lower than that of the PPH group [6.98% (3/43) versus 23.81% (10/42), χ2=4.647, P=0.031].ConclusionPPH+sphincterotomy could effectively relieve symptoms of severe mixed hemorrhoids, improve clinical efficacy, and reduce recurrence rate.
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.
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 understand the progress of molecular biology research on the pathogenesis of hemorrhoids. MethodThe literatures relevant to reseaches on the molecular biology of hemorrhoid pathogenesis in recent years had been reviewed. ResultsThe generally accepted theories of hemorrhoids included anal cushion downward movement theory, varicose vein theory, and vascular proliferation theory. The molecular biological studies related to the theory of anal cushion downward movement found that the increased expression of matrix metalloproteinase-9 and the abnormal expression of smooth muscle actin could damage the supporting tissue of anal cushion, causing the downward movement and prolapse of anal cushion, and then formed hemorrhoids; The molecular biology researches related to varicose vein theory found that the increase of nitric oxide synthase and transient receptor potential vanilloid 1 could promote the production of nitric oxide, causing varicose veins, and then leaded to the pathogenesis of hemorrhoids; The molecular biology researches related to vascular proliferation theory found that the low expressions of miR-412-5p and miR-4729, and the overexpressions of vascular endothelial growth factor and fibroblast growth factor were related to the vascular proliferation of hemorrhoids. In addition, the secondary inflammatory reaction after the onset of hemorrhoids also played an important role in the occurrence and development of hemorrhoids. ConclusionsThe occurrence and development of hemorrhoids is the result of the intersection and interaction of various mechanisms such as anal cushion downward movement, varicose veins, vascular proliferation, and secondary inflammatory reaction. The molecular biology research on the pathogenesis of hemorrhoids is helpful to better explain the occurrence of hemorrhoids from a microcosmic perspective, and lay a foundation for further exploring the etiology of hemorrhoids.
目的 探讨吻合器痔上黏膜环切术（PPH）的操作技巧、临床疗效及并发症。方法 根据患者具体情况，采用PPH术个性化治疗重度痔病患者128例，分析其手术操作技巧与临床疗效及术中、术后并发症的关系。结果 手术持续时间平均为30min，切除组织宽度平均为3.5cm。术中出血58例，其中渗血42例，搏动性出血16例。术后出血5例，吻合口感染1例；无大便失禁、吻合口狭窄。术后6个月随访，106例外脱痔块完全回缩，7例回缩不全，15例失访。结论 PPH术已被初步证明是一种微创、安全、有效的手术，但尚需进一步的经验积累及大规模临床试验加以验证。