自动痔疮套扎(RPH)结合剪口结扎术治疗中、重度混合痔的疗效观察

目的:探讨运用RPH结合剪口结扎术治疗中、重度混合痔的疗效。方法:将200例痔病患者按随机数字表法分成两组,对照组(剪口结扎术)和治疗组(RPH结合剪口结扎组),每组各100例,比较两组患者术后恢复及并发症情况。结果:RPH结合剪口结扎术组疗效优于对照组,两组比较差异有统计学意义(P0.05)。结论:RPH结合剪口结扎术治疗中、重度混合痔疗效满意,安全可行。     

经内镜痔上直肠黏膜套扎治疗内痔并脱出112例临床观察（含视频）

目的 评估经内镜痔上直肠黏膜套扎（super-hemorrhoidal banding,SHB）治疗内痔并脱出的安全性和有效性。方法 对2019年6月—2020年6月黔东南苗族侗族自治州人民医院收治的112例Ⅱ~Ⅲ度内痔患者进行SHB治疗。随访时间超过6个月。前瞻性观察SHB治疗内痔并脱出的疗效,术中、术后并发症及满意度。结果 共112例内痔患者接受SHB治疗,其中Ⅱ度74例（66.1%）,Ⅲ度38例（33.9%）。患者手术均成功,术中无肛门疼痛、出血等症状。术后出现不同程度肛门坠胀感,持续2~24 h后症状消除。5例Ⅲ度内痔患者术后出现排尿困难,局部热敷刺激膀胱后得到改善;1例Ⅲ度内痔患者术后第14天便血,在出血溃疡处再次套扎治疗出血停止。患者均完成随访,术后1个月随访,均无出血、疼痛、感染、狭窄等并发症。18例Ⅲ度内痔患者术后仍有部分痔脱出,但无出血等其他症状,其中6例患者再次行SHB治疗后无痔脱出。全部患者完成术后6个月随访,无并发症发生,调查患者满意度为100.0%。结论 SHB是一种有效、安全、简便的内镜下治疗内痔合并脱出的方法。     

Long-term Outcome of Stapled Hemorrhoidopexy for Grade III and Grade IV Hemorrhoids

Purpose  This study was designed to assess the long-term results of stapled hemorrhoidopexy in 291 patients with Grade III and Grade IV hemorrhoids after a minimum follow-up of five years. Methods  Records of patients submitted to stapled hemorrhoidopexy for Grade III and Grade IV hemorrhoids between January 1999 and December 2002 were retrospectively analyzed. Long-term outcome was evaluated with a standardized questionnaire and an office visit, including anorectal examination and rigid proctoscopy. Results  A total of 291 patients with Grade III (57.4 percent) and Grade IV (42.6 percent) hemorrhoids were evaluated. Intraoperative (20.3 percent) and postoperative (4.8 percent) bleeding was the most frequent complication. The questionnaire was submitted to all patients at a median follow-up of 73 (range 60–93) months. There were no symptoms related to hemorrhoids in 65.3 percent of patients, moderate symptoms in 25.4 percent of patients, and severe symptoms in 9.3 percent of patients. Fifty-three (18.2 percent) patients had recurrence. Reoperation was necessary in 21 (7.2 percent) patients (4 in Grade III hemorrhoids and 17 in Grade IV hemorrhoids; P < 0.001), with no recurrent symptoms and/or prolapse. Patient satisfaction for operation was 89.7 percent. Conclusions  Stapled hemorrhoidopexy is a safe and effective treatment for Grade III and Grade IV hemorrhoids. Recurrence requiring reoperation was higher in Grade IV hemorrhoids than in Grade III hemorrhoids. Reprints are not available.     

A Prospective,Randomized, Controlled Multicenter Trial Comparing Stapled Hemorrhoidopexy and Ferguson Hemorrhoidectomy: Perioperative and One-Year Results

PURPOSE There is a growing body of evidence supporting the lesser degrees of pain with stapled hemorrhoidopexy, also called the procedure for prolapse and hemorrhoids. However, there have been few randomized comparisons assessing both perioperative and long-term outcomes of the procedure for prolapse and hemorrhoids and Ferguson hemorrhoidectomy. Results are presented here from the first prospective, randomized, multicenter trial comparing these hemorrhoid procedures in the United States.METHODS Patients with prolapsing hemorrhoids (Grade III) were randomized to undergo the procedure for prolapse and hemorrhoids or Ferguson hemorrhoidectomy by colorectal surgeons who had training in using the stapling technique. Primary end points were acute postoperative pain, and hemorrhoid symptom recurrence requiring additional treatment at one-year follow-up from surgery.RESULTS A total of 156 patients (procedure for prolapse and hemorrhoids, 77; Ferguson, 79) completed randomization and the surgical procedure, 18 (procedure for prolapse and hemorrhoids, 12; Ferguson, 6) had significant protocol violations. One hundred seventeen patients (procedure for prolapse and hemorrhoids, 59; Ferguson, 58) returned for one-year follow-up. Demographic parameters, hemorrhoid symptoms, preoperative pain scores, and bowel habits were similar between groups. There were a similar number of patients with adverse events in each group (procedure for prolapse and hemorrhoids, 28 (36.4 percent) vs. Ferguson, 38 (48.1 percent); P = 0.138). Reoperation for an adverse effect was required in six (7.6 percent) Ferguson patients and in 0 patients having the procedure for prolapse and hemorrhoids (P = 0.028). Postoperative pain during the first 14 days, pain at first bowel movement, and need for postoperative analgesics were significantly less in the procedure for prolapse and hemorrhoids group. Control of hemorrhoid symptoms was similar between groups; however, significantly fewer patients having the procedure for prolapse and hemorrhoids required additional anorectal procedures during one-year follow-up (procedure for prolapse and hemorrhoids, 2 (2.6 percent), vs. Ferguson, 11 (13.9 percent); P = 0.01). Only four of the Ferguson patients (5 interventions) required additional procedures more than 30 days after surgery.CONCLUSIONS These data demonstrate that stapled hemorrhoidopexy offers the benefits of less postoperative pain, less requirement for analgesics, and less pain at first bowel movement, while providing similar control of symptoms and need for additional hemorrhoid treatment at one-year follow-up from surgery.Supported by Ethicon Endo-Surgery, Cincinnati, Ohio.Read at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 8, 2002. Winner of The New England Society of Colon and Rectal Surgeons Award.     

Retroperitoneal sepsis complicating stapled hemorrhoidectomy: report of a case and review of the literature

Stapled hemorrhoidectomy (mucosectomy) is a new technique that has recently been introduced for the treatment of third-degree and fourth-degree hemorrhoids and rectal mucosal prolapse. We present a case of severe retroperitoneal sepsis complicating stapled hemorrhoidectomy that was successfully treated by conservative means, further surgery therefore being avoided. The literature on the more serious complications associated with stapled hemorrhoidectomy is reviewed.     

改良单荷包四点牵引PPH在环状混合痔中的应用

目的比较改良单荷包四点牵引法与传统单荷包单点牵引法吻合器痔上黏膜环切术（PPH）治疗环状混合痔中的临床疗效。 方法选取2017年1月至2019年1月联勤保障部队第九〇〇医院普通外科收治的140例环状混合痔患者的临床资料,随机分成改良组和传统组,各70例,改良组采用单荷包四点牵引PPH,传统组采用单荷包单点牵引PPH。对两组临床疗效、术中情况、术后并发症及复发情况进行比较。 结果改良组与传统组治愈率分别为95.71%和82.86%,差异有统计学意义（χ²=6.048,P=0.014）。改良组切除的黏膜环的宽度（t=12.772,P<0.05）、黏膜环均匀程度（χ²=7.368,P<0.05）、痔核完全回缩（χ²=6.048,P<0.05）均优于传统组,差异有统计学意义;术后随访1年,改良组和传统组复发率分别为0.00%和7.14%,差异有统计学意义（χ²=5.185,P<0.05）;两组手术时间（t=1.081,P>0.05）和术中出血（χ²=0.085,P>0.05）差异无统计学意义;术后第1天、第7天的VAS疼痛评分差异无统计学意义（t_1d=0.731,t_7d=1.243;P>0.05）;改良组与传统组术后并发症总体发生率分别为8.57%和20%,差异无统计学意义（χ²=3.773,P>0.05）;两组住院时间差异无统计学意义（t=0.335,P>0.05）。 结论改良的单荷包四点牵引法PPH与传统单荷包单点牵引法PPH相比,术中切除的黏膜环较均匀一致,痔核回缩效果好,治愈率高,复发率低,值得临床应用。     

Impact of Less Invasive Treatments Including Sclerotherapy With a New Agent and Hemorrhoidopexy for Prolapsing Internal Hemorrhoids

Conventional hemorrhoidectomy is applied for the treatment of prolapsing internal hemorrhoids. Recently, less-invasive treatments such as sclerotherapy using aluminum potassium sulphate/tannic acid (ALTA) and a procedure for prolapse and hemorrhoids (PPH) have been introduced. We compared the results of sclerotherapy with ALTA and an improved type of PPH03 with those of hemorrhoidectomy. Between January 2006 and March 2009, we performed hemorrhoidectomy in 464 patients, ALTA in 940 patients, and PPH in 148 patients with second- and third-degree internal hemorrhoids according to the Goligher''s classification. The volume of ALTA injected into a hemorrhoid was 7.3 ± 2.2 (mean ± SD) mL. The duration of the operation was significantly shorter in ALTA (13 ± 2 minutes) than in hemorrhoidectomy (43 ± 5 minutes) or PPH (32 ± 12 minutes). Postoperative pain, requiring intravenous pain medications, occurred in 65 cases (14%) in hemorrhoidectomy, in 16 cases (1.7%) in ALTA, and in 1 case (0.7%) in PPH. The disappearance rates of prolapse were 100% in hemorrhoidectomy, 96% in ALTA, and 98.6% in PPH. ALTA can be performed on an outpatient basis without any severe pain or complication, and PPH is a useful alternative treatment with less pain. Less-invasive treatments are beneficial when performed with care to avoid complications.     

微电极射频电化学疗法治疗内痔60例疗效观察

为观察微电极射频电化学疗法治疗内痔的疗效,将内痔患者120例随机分为治疗组和对照组,每组60例。治疗组采用微电极射频电化学疗法治疗,对照组采用铜离子电化学疗法治疗。结果显示,两组对痔出血疗效相近（P〉0．05）,但治疗组凝固点少,治疗时间短（P〈0．05）。两组对痔脱出近期有效率相近（P〉0．05）。但治疗组术后肛管黏膜溃疡发生率少于对照组（P〈0．05）。结果表明,微电极射频电化学疗法使内痔的手术治疗由微创向无创的方向迈进了一步,其更具有实用性。