痔上粘膜环切钉合术后脱出的危险因素分析

目的分析痔上粘膜环切钉合术(PPH)后痔复发脱出的危险因素。方法回顾性分析2005-01/2012-02的178例PPH患者临床资料。结果本组患者随访时间2～87月,术后复发脱出48例(26.97%)。Ⅳ度内痔患者复发脱出率(45.16%)明显高于Ⅱ、Ⅲ度内痔患者;术后时间3年者脱出发生率(41.46%)明显高于≤3年者(14.58%),差异有统计学意义(P0.05)。性别、年龄、有无合并直肠粘膜脱垂及慢性便秘、单双荷包缝合、荷包距齿状线距离、吻合口距齿状线距离的脱出发生率间的差异无统计学意义(P0.05)。Logistic回归分析提示术后时间、痔分度、吻合口距齿状线距离是复发脱出的危险因素。结论术后时间、痔分度是PPH后痔复发脱出的独立危险因素。     

Benign anal conditions: haemorrhoids, fissures, perianal abscess, fistula-in-ano and pilonidal sinus

Benign perianal conditions represent a significant workload for the general surgeon and colorectal specialist. Patients present with a variety of symptoms, some of which may be difficult to distinguish from a more sinister cause without a careful history, examination and investigation. This article discusses the basic aetiology, clinical features and current evidence-based treatment recommendations for each of the conditions of haemorrhoids, fissures, perianal abscess, fistula-in-ano and pilonidal sinus. (Ischiorectal abscess is not addressed.)     

Prospective randomised clinical trial of single versus double purse-string stapled mucosectomy in the treatment of prolapsed haemorrhoids

Background and aims Despite the excellent results published on circular stapled mucosectomy (CSM), there is still some concern about the application of PPH-33 in the advanced haemorrhoidal disease, where a major prolapse may lead to insufficient resection and ensuing early recurrence. This study is aimed at comparing the outcomes after single purse-string CSM versus double purse-string CSM.Patients and methods A prospective randomised clinical trial of single versus double purse-string CSM for grade III–IV symptomatic haemorrhoids was used. One hundred consecutive patients were randomised to single (group 1, N=50) versus double purse-string CSM (group 2, N=50).Results The mean age was 50.7 years, with a predominance of males (63 vs. 37). Haemorrhoids were classified as grade III in 59% and grade IV in 41% of the patients. Mean follow-up was 26 months. Demographic and clinical features showed no differences between the two groups. The size of the resected doughnut was greater in group 2 (4.95 vs. 3.55 cm; p<0.05), as was the distance of the suture from the dentate line (3.56 vs. 3.16 cm; p<0.05). Early postoperative pain was significantly less in group 2 (linear analogue scale from 0 to 10), 2.08 vs. 3.56 (p<0.001). Postoperative haemorrhage was absent or minimal in 79% of patients. Three patients from group 1 reported persistent pain that was resolved within the first few postoperative months. There were two recurrences in group 1.Conclusion Double purse-string CSM resects a greater doughnut, increases the distance of the staple suture from the dentate line and reduces early postoperative pain in comparison to single purse-string CSM. Larger series are necessary to assert whether recurrence is lower.     

建立口腔负压治疗痔疮50例临床观察

目的：探讨建立口腔负压治疗痔疮疗效及其机理。方法：将100例痔疮患者随机分为2组,治疗组采用“人体经络-血-淋巴激活仪”治疗,对照组用马应龙麝香痔疮膏治疗,经治疗观察7天后,两组症状体征变化。结果：在治疗7天后治疗组总体疗效优于对照组,有显著性差异（P〈0．05）;治疗组与对照组比较,在消除水肿、坠胀方面均有极显著性差异（P〈0．01）,在止痛,止血,减轻脱垂,改善痔区黏膜充血方面差异显著（P〈0．05）。以上结果表明应用“人体经络-血-淋巴激活仪”可明显提高治疗痔疮症状总疗效。结论：“人体经络-血-淋巴激活仪”用于痔疮治疗有显著疗效,在消除水肿、缓解坠胀感、止痛、止血、减轻脱垂、改善痔区黏膜充血方面优于马应龙麝香痔疮膏。     

五味化痔胶囊治疗痔疮306例疗效观察

目的观察五味化痔胶囊治疗痔疮的有效性和安全性。方法将456例患者采用随机单盲法分为治疗组和对照组。治疗组306例,采用五味化痔胶囊治疗;对照组150例,采用迈之灵治疗。分别观察两组治疗前和治疗后第7天的疗效及不良反应。结果治疗组有效率92.16%,对照组有效率81.33%,两组比较差异有统计学意义(P0.05)。结论五味化痔胶囊治疗痔疮可有效改善患者出血、疼痛等症状,且未见明显的不良反应。     

针药并用治疗痔疮60例

目的:观察针药并用治疗痔疮的临床疗效。方法:选取痔疮患者120例,随机分为实验组和对照组各60例。对照组给予单纯运用中药治疗,实验组给予针药并用治疗。结果:实验组有效率96.67%,对照组有效率81.67%,实验组优于对照组(P<0.05)。结论:针药并用治疗痔疮临床疗效显著。     

痔上黏膜环形钉合术（PPH）治疗Ⅲ°～Ⅳ°痔70例临床分析

目的：评估PPH术后近远期疗效。方法：搜集70例PPH术患者的临床资料并随访18～26个月。结果：术后24h用药防止出血占25.7%,术后24h需止痛药占54.2%,术后尿潴留需要导尿占32.9%,以痔症状为主复发占20%,肛门痛占17.2%,肛门坠胀占11.4%,排便不净感及排便次数增多占11.4%,下腹部不适占7.1%。结论：PPH术后可发生较多的并发症,同时复发率较高,PPH术是对传统痔手术方法的一种补充,传统手术仍然是治疗Ⅲ°～Ⅳ°痔的金标准。     

Economic evaluation of the treatment of grade II haemorrhoids: a comparison of stapled haemorrhoidopexy and rubber band ligation

Objectives Haemorrhoidal disease is a common condition causing considerable distress to individuals and significant cost to healthcare services. This paper explored the cost‐effectiveness of stapled haemorrhoidopexy (SH) compared with the non‐surgical intervention, rubber band ligation (RBL), for grade II symptomatic circumferential haemorrhoids. Method An economic evaluation alongside a randomized controlled trial conducted between October 2002 and February 2005. Adults were recruited and randomized to either SH or RBL. The same surgeon performed all procedures and investigators were blinded until analyses were completed. Primary outcomes measured at 52 weeks were cumulative costs to the NHS, clinical diagnosis of recurrence and quality adjusted life years (QALYs). Results Sixty symptomatic men and women with confirmed clinical diagnosis of grade II symptomatic haemorrhoids were randomized. Loss to follow‐up was up to 10% at 52 weeks. The mean cost for SH was greater than RBL (mean difference: £1483, 95% CI: 1339–1676); disease recurrence was lower (OR = 0.18, 95% CI: 0.03–0.86); and there was no evidence of a statistically significant difference in QALYs (?0.014, 95% CI: –0.076 to 0.051). SH was associated with a modest incremental cost per recurrence avoided at 12 months follow‐up (£4945). Based on current data, it was considered highly unlikely to be cost‐effective in terms of incremental cost per QALY. Conclusions There is insufficient evidence about the cost‐effectiveness of SH for grade II haemorrhoids to recommend its routine use in place of RBL. Further information is needed from larger trials with a longer‐term follow‐up to inform subsequent economic evaluation.