Comparative Study of Anorectal Pressure after Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Hemorrhoidectomy in The Treatment of Mixed Hemorrhoid of Ⅲ-Degree_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUYang ,  LUMing

Department of Anorectal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;

Corresponding?author：

LUMing, Email: luming123luming@163.com

Keywords：

Mixed hemorrhoids of Ⅲ-degree; Procedure for prolapse and hemorrhoids; Milligan-Morgan hemorr- hoidectomy; Anorectal pressure; Prospective study

DOI：

10.7507/1007-9424.20160183

Video：

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Objective To compare the postoperative anorectal pressure after procedure for prolapse and hemorrhoids (PPH) and Milligan-Morgan hemorrhoidectomy (MMH) in treatment of patients with mixed hemorrhoid of Ⅲ-degree. Methods In total of 112 patients with mixed hemorrhoid of Ⅲ-degree who underwent PPH (n=60) or MMH (n=52) in The First Affiliated Hospital of Xinjiang Medical University between March 2014 to March 2015 were prospectively enrolled, the type of surgery was according to patients’ individual choice. In 6 months after operation, all patients under-went the examination of anorectal manometry which including rectal anal inhibitory reflex, rectal resting pressure, anal resting pressure, maximal anal contractive pressure, and anal canal length of high pressure belt. Results In 6 months after operation, the positive rate of rectal anal inhibitory reflex 〔88.3% (53/60) vs. 61.5% (32/52)〕 , anal resting pressure 〔(56.42± 2.25) mm Hg vs. (46.31±2.58) mm Hg〕, and anal canal length of high pressure belt 〔(3.35±0.12) cm vs. (2.29±0.23) cm〕 of PPH group were all significantly higher than those of MMH group (P＜0.05), but there was no statistical significance between PPH group and MMH group in rectal resting pressure 〔(5.51±1.26) mm Hg vs. (5.39±1.85) mm Hg〕 and maximal anal contractive pressure 〔(156.64±9.78) mm Hg vs. (155.32±8.53) mm Hg〕, P>0.05. Conclusion PPH and MMH are all effective to treat mixed hemorrhoids of Ⅲ-degree, but PPH is more positive in protection of anal function.

Citation： LIUYang, LUMing. Comparative Study of Anorectal Pressure after Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Hemorrhoidectomy in The Treatment of Mixed Hemorrhoid of Ⅲ-Degree. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 687-690. doi: 10.7507/1007-9424.20160183 Copy

1.	?朱軍, 丁健華, 趙克, 等. 吻合器痔上黏膜環切釘合術與開放式外剝內扎痔切除術治療Ⅲ度痔遠期療效比較. 中國實用外科雜志, 2012, 32(5): 398-402.
2.	Laughlan K, Jayne DG, Jackson D, et al. Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review. Int J Colorectal Dis, 2009, 24(3): 335-344.
3.	劉洪喜, 任遠. 吻合器痔上黏膜環切術聯合外痔切除術治療重度混合痔的療效分析. 中國臨床醫學, 2014, 21(6): 665-667.
4.	Lu M, Shi GY, Wang GQ, et al. Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids. World J Gastroenterol, 2013, 19(30): 5011-5015.
5.	劉揚, 劉青, 楊潤清, 等. PPH聯合外剝內扎術及皮橋整形術治療重度環狀混合痔的臨床療效觀察. 中國普通外科雜志, 2015, 24(2): 297-299.
6.	王國強, 劉揚, 劉青, 等. 吻合器痔上黏膜環切術的近遠期療效及安全性的Meta分析. 中華外科雜志, 2013, 51(11): 1034-1038.
7.	中華醫學會外科學分會結直腸肛門外科學組, 中華中醫藥學會肛腸病專業委員會, 中國中西醫結合學會結直腸肛門病專業委員會. 痔臨床診治指南(2006版). 中華胃腸外科雜志, 2006, 9(5): 461-463.
8.	Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device：a new procedure. 6th ed. Rome: World Congress of Endoscopic Surgery, 1998: 777-784.
9.	Milligan ETC, Morgan CN. Surgical anatomy of the anal canal and operative treatment of hemorrhoids. Lancet, 1937, 2(3): 1119-1124.
10.	董曉妮, 唐迎春. 吻合器痔上黏膜環切釘合術與超聲引導下痔動脈結扎術治療Ⅲ度混合痔術后肛管直腸壓力的比較研究. 中華胃腸外科雜志, 2013, 16(12): 1183-1186.
11.	王智鳳, 柯美云, 孫曉紅, 等. 功能性便秘患者肛門直腸動力學和感覺功能測定及其臨床意義. 中華消化雜志, 2004, 24(9): 526-529.
12.	Kuiken SD, Lindeboom R, Tytgat GN, et al. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther, 2005, 22(2): 157-164.
13.	費賢彬, 彭俊杰, 吳堅, 等. 吻合器痔上黏膜環切術治療重度痔病128例臨床觀察. 中國普外基礎與臨床雜志, 2012, 19(4): 440-442.
14.	Perez F, Arroyo A, Serrano P, et al. Prospective clinical and mano-metric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano. Int J Colorectal Dis, 2006, 21(6): 522-526.
15.	林細州, 陳艷, 陸小鋒, 等. 高分辨率肛門直腸測壓與生物反饋治療在出口梗阻型便秘患者中的應用. 實用醫學雜志, 2015, 31(17): 2851-2854.
16.	Rao SS, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome Ⅱ criteria in dyssynergic defe-cation (Anismus). Neurogastroenterol Motil, 2004, 16(5): 589-596.
17.	Kouraklis G, Andromanakos N. Anorectal incontinence: aetiology, pathophysiology and evaluation. Acta Chir Belg, 2004, 104(1): 81-91.
18.	路明. 直腸內脫垂伴環狀混合痔所致便秘臨床治療對比研究. 新疆: 新疆醫科大學, 2014: 33-37.
19.	Wa?ega P, Scheyer M, Kenig J, et al. Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrho-idal artery ligation: functional results after 1-year follow-up. Surg Endosc, 2008, 22(11): 2379-2383.
20.	Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy—costand effectiveness. Randomized, controlled trial including incontin-ence scoring, anorectal manometry, and endoanal ultrasound assess-ments at up to three months. Dis Colon Rectum, 2000, 43(12): 1666-1675.
21.	Tjandra JJ, Chan MK. Systematic review on the procedure for prol-apse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum, 2007, 50(6): 878-892.

1. ?朱軍, 丁健華, 趙克, 等. 吻合器痔上黏膜環切釘合術與開放式外剝內扎痔切除術治療Ⅲ度痔遠期療效比較. 中國實用外科雜志, 2012, 32(5): 398-402.
2. Laughlan K, Jayne DG, Jackson D, et al. Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review. Int J Colorectal Dis, 2009, 24(3): 335-344.
3. 劉洪喜, 任遠. 吻合器痔上黏膜環切術聯合外痔切除術治療重度混合痔的療效分析. 中國臨床醫學, 2014, 21(6): 665-667.
4. Lu M, Shi GY, Wang GQ, et al. Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids. World J Gastroenterol, 2013, 19(30): 5011-5015.
5. 劉揚, 劉青, 楊潤清, 等. PPH聯合外剝內扎術及皮橋整形術治療重度環狀混合痔的臨床療效觀察. 中國普通外科雜志, 2015, 24(2): 297-299.
6. 王國強, 劉揚, 劉青, 等. 吻合器痔上黏膜環切術的近遠期療效及安全性的Meta分析. 中華外科雜志, 2013, 51(11): 1034-1038.
7. 中華醫學會外科學分會結直腸肛門外科學組, 中華中醫藥學會肛腸病專業委員會, 中國中西醫結合學會結直腸肛門病專業委員會. 痔臨床診治指南(2006版). 中華胃腸外科雜志, 2006, 9(5): 461-463.
8. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device：a new procedure. 6th ed. Rome: World Congress of Endoscopic Surgery, 1998: 777-784.
9. Milligan ETC, Morgan CN. Surgical anatomy of the anal canal and operative treatment of hemorrhoids. Lancet, 1937, 2(3): 1119-1124.
10. 董曉妮, 唐迎春. 吻合器痔上黏膜環切釘合術與超聲引導下痔動脈結扎術治療Ⅲ度混合痔術后肛管直腸壓力的比較研究. 中華胃腸外科雜志, 2013, 16(12): 1183-1186.
11. 王智鳳, 柯美云, 孫曉紅, 等. 功能性便秘患者肛門直腸動力學和感覺功能測定及其臨床意義. 中華消化雜志, 2004, 24(9): 526-529.
12. Kuiken SD, Lindeboom R, Tytgat GN, et al. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther, 2005, 22(2): 157-164.
13. 費賢彬, 彭俊杰, 吳堅, 等. 吻合器痔上黏膜環切術治療重度痔病128例臨床觀察. 中國普外基礎與臨床雜志, 2012, 19(4): 440-442.
14. Perez F, Arroyo A, Serrano P, et al. Prospective clinical and mano-metric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano. Int J Colorectal Dis, 2006, 21(6): 522-526.
15. 林細州, 陳艷, 陸小鋒, 等. 高分辨率肛門直腸測壓與生物反饋治療在出口梗阻型便秘患者中的應用. 實用醫學雜志, 2015, 31(17): 2851-2854.
16. Rao SS, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome Ⅱ criteria in dyssynergic defe-cation (Anismus). Neurogastroenterol Motil, 2004, 16(5): 589-596.
17. Kouraklis G, Andromanakos N. Anorectal incontinence: aetiology, pathophysiology and evaluation. Acta Chir Belg, 2004, 104(1): 81-91.
18. 路明. 直腸內脫垂伴環狀混合痔所致便秘臨床治療對比研究. 新疆: 新疆醫科大學, 2014: 33-37.
19. Wa?ega P, Scheyer M, Kenig J, et al. Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrho-idal artery ligation: functional results after 1-year follow-up. Surg Endosc, 2008, 22(11): 2379-2383.
20. Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy—costand effectiveness. Randomized, controlled trial including incontin-ence scoring, anorectal manometry, and endoanal ultrasound assess-ments at up to three months. Dis Colon Rectum, 2000, 43(12): 1666-1675.
21. Tjandra JJ, Chan MK. Systematic review on the procedure for prol-apse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum, 2007, 50(6): 878-892.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study of Anorectal Pressure after Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Hemorrhoidectomy in The Treatment of Mixed Hemorrhoid of Ⅲ-Degree

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