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.
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.
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.
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．
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.
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.
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.
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 observe the effect of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviated as combined therapy) in the treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure.MethodsFrom January 2016 to June 2018, the patients with grade Ⅲ–Ⅳ mixed hemorrhoids who underwent surgical treatment in this hospital were selected for the prospective study, including 100 patients with high pressure (>70 mm Hg, 1 mm Hg=0.133 kPa) and 100 patients with low pressure (≤70 mm Hg), then which were divided into an experimental group and a control group according to the random number table method (with 50 cases in each group). The patients in the control group underwent the PPH and in the experimental group underwent the combined therapy. The therapeutic effect and perioperative indicators were observed in each group, Visual Analogue Scale (VAS) was used to evaluate the degree of pain before and after the operation, the incidence of complications and the recurrence rate of symptoms were observed, the factors influencing the therapeutic effect of combined therapy were analyzed.ResultsWhether for the patients with high or low rectal and anal canal resting pressure, although the operation time of the experimental group was significantly longer than that of the control group (t=8.996, P<0.001; t=8.927, P<0.001), the total effective rate was higher (χ2=7.294, P=0.007; χ2=6.775, P=0.009), the length of stay in hospital was shorter (t=11.922, P<0.001; t=11.442, P<0.001), the hospital expenses decreased significantly (t=2.226, P=0.028; t=2.562, P=0.012), the VAS score at 24 h and 72 h after operation were lower (24 h: t=12.659, P<0.001; t=12.191, P<0.001; 72 h: t=9.920, P<0.001; t=9.901, P<0.001), the incidence of postoperative complications was lower (χ2=7.484, P=0.006; χ2=11.416, P=0.001) in the experimental group as compared with the control group; there was no significant difference between the two groups (χ2=1.042, P=0.307; χ2=0.211, P=0.646). The course of disease and the grade of internal hemorrhoids were the independent factors influencing the marked efficiency of combined therapy (χ2=7.417, P=0.009; χ2=4.286, P=0.017).ConclusionsCombined therapy is effective in treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure, it could accelerate recovery of patients and relieve pain. It should be paid attention to patients with long course of disease and severe degree of internal hemorrhoids.
ObjectiveTo study the curative effect and postoperative anorectal dynamics change of tissue-selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) respectively combined with mixed Milligan-Morgan and lauromacrgol injection in the treatment of Ⅲ–Ⅳ degree mixed hemorrhoid.MethodsClinical data of 158 patients with Ⅲ–Ⅳdegree mixed hemorrhoid who received operation in the Department of Colorectal and Anal Surgery, Chaoyang Central Hospital, from May 2016 to March 2018 were analyzed retrospectively, the observation group (TST+Milligan-Morgan+lauromacrgol injection, 80 cases) and control group (PPH+Milligan-Morgan+lauromacrgol injection, 78 cases). The clinical efficacy, adverse reactions, postoperative complications and recurrence of the two groups were observed, and the changes of anorectal dynamic indexes before and after operation were observed.ResultsPostoperative symptoms of mixed hemorrhoid prolapse could be alleviated by 100% in both the observation group and the control group, and the relief rate of hematochezia was 93.8% and 92.3%, respectively, and the effective rate of 1 year after surgery was 97.5% and 94.9%, respectively. Comparison between the two groups showed no statistical difference (P>0.05). The operative time, intraoperative blood loss, VAS pain score and hospital stay of the observation group were all better than those of the control group (P<0.05). In terms of postoperative massive hemorrhage and anastomotic stenosis, although the incidence rate of the control group was higher than that of the observation group (3.8% vs. 1.3% and 2.6% vs. 0.0%, respectively), there was no statistical significance in the two groups (P>0.05). Postoperative anal drop, stool urgency, postoperative urinary retention and postoperative stimulation of anal papilla hypertrophy and proliferation complications were significantly better in the observation group than in the control group (P<0.05). The difference of maximum anal systolic pressure (MASP) in the two groups of patients between before and after surgery and the comparison of MASP results between the two groups after surgery showed no statistical differences (P>0.05). The differences of resting anal sphincter pressure (RASP) and rectal sensory threshold volume (RSTV) between before and after operation were not statistically significant (P>0.05). The difference of rectal maximum threshold volume (RMTV) value and the comparison of RASP, RSTV and RMTV value between the two groups after surgery showed that the observation group were superior to the control group and the differences were statistically significant (P<0.05).ConclusionsTST or PPH combined with Milligan-Morgan and lauromacrgol injection both are effective and minimally invasive methods for the treatment of Ⅲ–Ⅳ degree mixed hemorrhoid. However, the observation group has shorter operative time and hospital stay, less intraoperative blood loss, and lower postoperative pain score. What is more important is that the postoperative complications are less and the anal function is protected to the maximum extent, and the quality of life of patients after operation is greatly improved.