Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Hui ¹ , XU Su ¹ , YANG Xiaoling ¹ ,  CHEN Hongjin ² , GU Yunfei ² , YANG Bolin ²

1. The Hospital Affiliated to Nanjing University of Chinese Traditional Medicine, Nanjing, Jiangsu 210029, P.R.China;
2. Department of Anorectal, The First Affiliated Hospital of Nanjing University of Chinese Traditional Medicine/Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R.China;

Corresponding?author：

CHEN Hongjin, Email: chjltp@163.com

Keywords：

pouched suture; external dissection and internal ligation; mixed hemorrhoids

DOI：

10.7507/1007-9424.201609071

Video：

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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.

Citation： WANG Hui, XU Su, YANG Xiaoling, CHEN Hongjin, GU Yunfei, YANG Bolin. Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 453-457. doi: 10.7507/1007-9424.201609071 Copy

1.	?任東林, 胡邦. 重視肛門直腸良性疾病的診治. 中華胃腸外科雜志, 2014, 17(12): 1161-1163.
2.	田振國, 陳平. 中國成人常見肛腸疾病流行病學調查. 武漢: 武漢大學出版社, 2015: 33-61.
3.	Imbelloni LE, Vieria EM, Carneiro AF. Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: A controlled clinical study. J Coloproctol, 2012, 32(3): 291-296.
4.	Marino AW Jr. Symposium: anorectal surgery—hemorrhoids. Dis Colon Rectum, 1980, 23(4): 211-222.
5.	Milligan ETC, Morgan CN, Jones LE,et al. Surgical anatomy of the anal canal, and the operative treatment of hemorrhoids. Lancet, 1937, 2(11): 1119-1124.
6.	Towliat Kashani SM, Mehrvarz S, Mousavi Naeini SM,et al. Milligan-Morgan hemorrhoidectomy vs stapled hemorrhoidopexy. Trauma Mon, 2012, 16(4): 175-177.
7.	丁義江, 皇甫少華. 痔診斷和治療指南 (2010 修訂版). 中華消化外科雜志, 2012, 11(3): 243-247.
8.	國家中醫藥管理局. 中華人民共和國中醫藥行業標準?中醫病證診斷療效標準 (2012 版).北京: 中國醫藥科技出版社, 2012: 53-54.
9.	Woodforde JM, Merskey H. Some relationships between subjective measures of pain. J Psychosom Res, 1972, 16(3): 173-178.
10.	楊紀紅, 牟潔霏, 何洪波. 肛門內括約肌部分切開術在混合痔外剝內扎術中的應用. 華西醫學, 2014, 29(3): 508-510.
11.	王秀珍, 郭琳, 張宏璽. TST 與外剝內扎術治療混合痔的臨床療效觀察. 結直腸肛門外科, 2015, 21(2): 109-111.
12.	應欣, 曾莉, 錢海華. 痔手術研究進展. 現代中西醫結合雜志, 2012, 21(31): 3529-3532.
13.	鄒占云, 王愛華. 吻合器痔切閉術與傳統痔切閉術的臨床療效比較. 湖南中醫學院學報, 2005, 25(6): 48-49.
14.	Panarese A, Pironi D, Vendettuoli M,et al. Stapled and conventional Milligan-Morgan hemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis, 2012, 27(4): 483-487.
15.	Sammarco G, Ferrari F, Carpino A,et al. PPHvs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse. Ann Ital Chir, 2013, 23(7): 84-87.
16.	唐茂山. 自動痔瘡套扎術與外剝內扎術治療Ⅲ、Ⅳ期混合痔的對照研究. 中華全科醫學, 2016, 14(3): 397-399.
17.	王靜, 黃峰. 外剝內扎注射加內括約肌松解術治療環狀混合痔臨床觀察. 中國中醫急癥, 2015, 24(8): 1446-1447.
18.	鄧志灝, 趙寶明. 痔外剝內扎術后的解痙治療. 世界華人消化雜志, 2013, 21(19): 1828-1833.
19.	李宇飛, 何孝康, 王曉鋒, 等. 痔術后肛緣水腫的防治策略.結直腸肛門外科, 2014, 20(1): 72-75.
20.	倪海葉, 任清文. 兩種手術方法治療混合痔的療效比較. 中國普外基礎與臨床雜志, 2010, 17(8): 847-848.
21.	Amoli HA, Notash AY, Shahandashti FJ,et al. A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Colorectal Dis, 2011, 13(3): 328-332.

1. ?任東林, 胡邦. 重視肛門直腸良性疾病的診治. 中華胃腸外科雜志, 2014, 17(12): 1161-1163.
2. 田振國, 陳平. 中國成人常見肛腸疾病流行病學調查. 武漢: 武漢大學出版社, 2015: 33-61.
3. Imbelloni LE, Vieria EM, Carneiro AF. Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: A controlled clinical study. J Coloproctol, 2012, 32(3): 291-296.
4. Marino AW Jr. Symposium: anorectal surgery—hemorrhoids. Dis Colon Rectum, 1980, 23(4): 211-222.
5. Milligan ETC, Morgan CN, Jones LE,et al. Surgical anatomy of the anal canal, and the operative treatment of hemorrhoids. Lancet, 1937, 2(11): 1119-1124.
6. Towliat Kashani SM, Mehrvarz S, Mousavi Naeini SM,et al. Milligan-Morgan hemorrhoidectomy vs stapled hemorrhoidopexy. Trauma Mon, 2012, 16(4): 175-177.
7. 丁義江, 皇甫少華. 痔診斷和治療指南 (2010 修訂版). 中華消化外科雜志, 2012, 11(3): 243-247.
8. 國家中醫藥管理局. 中華人民共和國中醫藥行業標準?中醫病證診斷療效標準 (2012 版).北京: 中國醫藥科技出版社, 2012: 53-54.
9. Woodforde JM, Merskey H. Some relationships between subjective measures of pain. J Psychosom Res, 1972, 16(3): 173-178.
10. 楊紀紅, 牟潔霏, 何洪波. 肛門內括約肌部分切開術在混合痔外剝內扎術中的應用. 華西醫學, 2014, 29(3): 508-510.
11. 王秀珍, 郭琳, 張宏璽. TST 與外剝內扎術治療混合痔的臨床療效觀察. 結直腸肛門外科, 2015, 21(2): 109-111.
12. 應欣, 曾莉, 錢海華. 痔手術研究進展. 現代中西醫結合雜志, 2012, 21(31): 3529-3532.
13. 鄒占云, 王愛華. 吻合器痔切閉術與傳統痔切閉術的臨床療效比較. 湖南中醫學院學報, 2005, 25(6): 48-49.
14. Panarese A, Pironi D, Vendettuoli M,et al. Stapled and conventional Milligan-Morgan hemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis, 2012, 27(4): 483-487.
15. Sammarco G, Ferrari F, Carpino A,et al. PPHvs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse. Ann Ital Chir, 2013, 23(7): 84-87.
16. 唐茂山. 自動痔瘡套扎術與外剝內扎術治療Ⅲ、Ⅳ期混合痔的對照研究. 中華全科醫學, 2016, 14(3): 397-399.
17. 王靜, 黃峰. 外剝內扎注射加內括約肌松解術治療環狀混合痔臨床觀察. 中國中醫急癥, 2015, 24(8): 1446-1447.
18. 鄧志灝, 趙寶明. 痔外剝內扎術后的解痙治療. 世界華人消化雜志, 2013, 21(19): 1828-1833.
19. 李宇飛, 何孝康, 王曉鋒, 等. 痔術后肛緣水腫的防治策略.結直腸肛門外科, 2014, 20(1): 72-75.
20. 倪海葉, 任清文. 兩種手術方法治療混合痔的療效比較. 中國普外基礎與臨床雜志, 2010, 17(8): 847-848.
21. Amoli HA, Notash AY, Shahandashti FJ,et al. A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Colorectal Dis, 2011, 13(3): 328-332.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids

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