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.
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.
ObjectiveTo summarize the research progression of Doppler-guided hemorrhoidal artery ligation in the treatment of hemorrhoids. MethodsThe related literatures in recent years were reviewed, and to investigate the operation principle, operation process, the indications and effects, and existing problems of Doppler-guided hemorrhoidal artery ligation. ResultsThe surgical principle of Doppler-guided hemorrhoidal artery ligation make use of Doppler ultrasound looking for hemorrhoidal artery, and ligation it directly.It's best indication is Ⅱ or Ⅲ degree hemorrhoids or mixed hemorrhoid with grade Ⅰ or Ⅲ mainly, especially for bleeding hemorrhoids disease curative effect is better.This surgical method has lots of advantages, such as less invasive, quick recovery, and low incidence of complications.But it is no significant treatment effect for the external hemorrhoids, therefore, the procedure does not apply to external hemo-rrhoids and mixed hemorrhoids dominated by external hemorrhoids. ConclusionsDoppler-guided hemorrhoidal artery ligation has the advantage of minimally invasive, it is a safe and effective treatment for Ⅱ and Ⅲ degree internal hemorr-hoids or Ⅱ and Ⅲ degree mixed hemorrhoids dominated by internal hemorrhoids.
Objective To compare the therapeutic effect of procedure for prolapse and hemorrhoids （PPH） and Block repair procedure for rectocele．Methods A retrospective study of 62 patients with surgical treatment for rectocele was analyzed．The patients were divided into PPH group （n=32） and Block group （n=30） according to the different operation procedure．The symptoms score of improvement of the patients after surgery was compared between the two groups， including operation time，intraoperative blood loss， postoperative pain score， required analgesic times， postoperative complications，hospitalization time，and hospitalization expenses．Results The symptoms of constipation of patients in two groups was significantly improved afer operation．Comparing one month with three months of Longo’s obstructed defecation syndrome （ODS） score after the operation，there was no significant difference in the PPH group（P＞0.05）， but significant difference in the Block group（P＜0.01）．Although the expenses of the PPH group was much higher than that of the Block group （P＜0.01）， the outcomes of the PPH group were much better than those of the Block group （P＜0.01）， including the postoperative Longo’s ODS score of one month and three months，operation time，intraoperative blood loss， postoperative pain score，required analgesic times，and hospitalization time．Two cases of lightly postoperative incontinence occurred in the PPH group，but completely recovered after three months in the clinical follow-up．Conclusions The PPH is as safe and effective as Block repair procedure for rectocele. The short time effect and lower recurrence rate of the PPH are better than those of the Block repair procedure．
Objective To evaluate the safety and efficacy of procedure for prolapse and hemorrhoids （PPH） combined with Shaobei injection in treatment for obstructed defecation syndrome （ODS） caused by rectocele. Methods Seventy-two female patients with rectocele from December 2009 to January 2011 in this hospital were divided into PPH combined with Shaobei injection group （36 cases） and only PPH group （36 cases）. The Longo ODS score was performed on week one，month one，month three，and month six after operation，respectively；pain was evaluated， complications such as urine retention，postoperative bleeding，and anal function were observed；hospital stay and recovery work time were recorded in two groups. Results All patients were followed up for 6 months，there were no significant differences in complications，hospital stay，and the Longo ODS score on week one and month one after operation between two groups （P＞0.05）. But the Longo ODS score of the PPH combined with Shaobei injection group on month three and month six after operation were significantly lower than those of the only PPH group （P＜0.05）. Conclusion PPH combined with Shaobei injection has a better efficacy as compared with only PPH，and at least as safe as only PPH.
ObjectiveTo observe the therapeutic efficacy of ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation for the treatment of four degree mixed hemorrhoids. MethodsThe patients with four degree mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2023 to June 2023 were included as the study subjects, then were randomly averagely divided into an observation group (underwent ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation) and a control group (underwent Milligan-Morgan hemorrhoidectomy) by a random number table method. The therapeutic efficacy, total hospitalization time, operation time, intraoperative blood loss, wound healing time, hospitalization costs, postoperative pain score, bleeding score, wound edema score, postoperative complications (anal stenosis, urinary retention, anal incontinence), and recurrence were compared between the two groups. ResultsA total of 100 patients with four degree mixed hemorrhoids treated in this hospital were included, with 50 patients in each group. There were no statistically significant differences in the general information such as the gender, age, disease course, body mass index, hematochezia, and tumor prolapse between the two groups (P>0.05). ① The overall therapeutic efficacy both the observation group and the control group was well (100% versus 96.0%, Fisher exact test, P=0.495). ② The observation group had less total hospitalization time, operation time, intraoperative blood loss, hospitalization costs, and wound healing time as compared with the control group (P<0.05). ③ The differences in the interaction effects of the time-group for the points of postoperative pain, bleeding, and wound edema were not statistically significant (χ2=6.668, P=0.083; χ2=5.500, P=0.139; χ2=6.204, P=0.102). However, the main effects of group (χ2=5.073, P=0.024; χ2=7.107, P=0.008; χ2=8.857, P=0.003) and time (χ2=188.526, P<0.001; χ2=212.472, P<0.001; χ2=185.110, P<0.001) showed statistically significant differences. The points of postoperative pain, bleeding, and wound edema in the observation group were statistically lower than thoes in the control group (χ2=9.323, P=0.002; χ2=18.133, P<0.001; χ2=6.232, P=0.013). ④ The incidences of postoperative urinary retention and anal stenosis in the observation group were lower than those in the control group (P=0.046 and 0.031, respectively), there were no statistically significant differences in the incidences of incontinence and postoperative recurrence between the two groups (P>0.05). ConclusionFrom the preliminary research results of this study, ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation has a better efficacy in treating four degree mixed hemorrhoids, with a smaller wound, faster healing, higher safety, and fewer complications.
ObjectiveTo explore the effect of " washing, blowing and plugging” triple therapy on wound treatment after procedure for prolapse and hemorrhoids (PPH) operation.MethodsTwo hundreds and four patients with moderate to severe hemorrhoids treated by PPH from June 2017 to September 2018 in the Fifth Hospital of Zhangjiakou City of Hebei province were selected as study subjects and divided into two groups according to the random number table, the control group received saline fumigation followed by sitz bath and conventional wound dressing change on the second day after operation, the observation group were treated with " washing, blowing and plugging” triple therapy and routine wound dressing change on the 2nd day after operation. The clinical efficacy, wound pain, wound exudation, skin margin edema, hemorrhage, granulation tissue filling time and complete wound healing time were compared between the two groups.ResultsThere was no significant difference in the effective rate between the observation group and the control group in degree Ⅱ hemorrhoids (P>0.05), while the effective rates of patients with degree Ⅲ and Ⅳ hemorrhoids were higher than those of the control group (P<0.05). The visual analogue scale (VAS), wound exudation, skin margin edema and hemorrhage scores of the two groups decreased gradually with time (P<0.05), meanwhile, the scores of VAS, wound exudation, skin margin edema and hemorrhage at each time point in the observation group were lower than those in the control group (P<0.05). The granulation tissue filling time and complete wound healing time in the observation group were shorter than those in the control group (P<0.05).ConclusionsAfter PPH operation, the " washing, blowing and plugging” triple therapy has definite clinical effect, can significantly improve wound pain, wound exudation, skin margin edema and hemorrhage, and effectively shorten the wound healing time.
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 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.