吻合器痔环切术经肛引流应用观察

目的：探讨采用吻合器经肛管引流治疗重度痔降低术后并发症的影响。方法：随机将101例Ⅲ～Ⅳ期混合痔及内痔患者分为引流组48例和非引流组53例，回顾性分析两组施行PPH经肛引流及非引流术后的临床资料。结果：两组间数据比较伤口渗血（12h～48h）、排便异常指标，对照显示差异显著（P〈0．05）。结论：该术式具有安全、有效、术时短、恢复快及术后并发症明显降低等优点。     

Stapled Hemorrhoidopexy: A Prospective Study From Pathology to Clinical Outcome

Stapled hemorrhoidopexy is widely accepted to treat hemorrhoids, but serious complications have been reported. In this prospective audit, we correlated clinical outcome with pathological findings. From January 2003 to April 2007, 94 patients underwent hemorrhoidopexy. Macroscopic appearance of the specimen (shape, size, and depth) was recorded. Microscopically, the presence of columnar, transitional, and squamous epithelium, the involvement of circular/longitudinal smooth muscle, and features of mucosal prolapse were assessed. Clinical outcome was evaluated by a validated questionnaire. Postoperative pain, secretion, and bleeding durations were 12.7 +/− 10.6, 5.6 +/− 9.6, and 6.3 +/− 8.4 days. Patient’s return to work averaged 16.7 +/− 10.7 days. Fissure, skin tags, and anal strictures were observed in 23.4%. Seven patients experienced pain for a significantly longer period of time. All specimens contained columnar mucosa, but 29.8% contained columnar and transitional epithelium and 12.8% contained columnar, anal transitional, and stratified squamous epithelium. Smooth muscle was observed in 62.7%. Pain was significantly increased if transitional epithelium was present in the specimen. No correlation or differences were observed if smooth muscle was present, although postoperative bleeding was more frequent. Hemorrhoidopexy is safe and effective. The specimen should always be sent for pathology examination. Only columnar epithelium should be present and, although the presence of smooth muscle does not influence the outcome in terms of functional results, its presence may play a role in postoperative bleeding. Presented as poster at the Digestive Disease Week, May 2007, Washington, USA     

Treatment of Hemorrhoids in Day Surgery: Stapled Hemorrhoidopexy vs Milligan–Morgan Hemorrhoidectomy

Background Recently, it has been demonstrated that surgical treatment of hemorrhoids in a day-care basis is possible and safe. The aim of this study was to compare the Longo stapled hemorrhoidopexy (SH) and the Milligan–Morgan hemorrhoidectomy (MMH). Methods One hundred seventy one patients (95 cases in SH group and 76 cases in MMH group) entered the study: 83 cases were III degree hemorrhoids, 88 IV degree. A priori and a post hoc power analysis were performed. Results, prospectively collected, were compared using chi squared test and student t test. Visual analog scale was used for pain evaluation. Postoperative pain, duration of pain, wound secretion, bleeding, resumption of a normal lifestyle, and postoperative complication were evaluated. Results Surgical time was 28.41 ± 10.78 for MMH and 28.30 ± 13.28 min in SH (P = 0.94). Postoperative pain was not different between MMH and SH during the first two postoperative days (4.73 ± 2.91 vs 5.1 ± 3.048; P = 0.4), during the following 6 days, patients treated with SH had less pain (4.63 ± 2.04 in MMH vs 3.60 ± 2.35 in SH; P = 0.006). In the SH group, seven patients needed further hospital stay for complicated course. SH showed higher incidence of anal fissure compared with MMH (6.3% vs 0%; P = 0.025) but no differences in urinary retention, anal stricture, urgency, or anal hemorrhage. Conclusions This study confirms that SH is associated with less postoperative pain and shorter postoperative symptoms, compared with MMH. SH may be a viable addition to the therapy for hemorrhoids with some advantages in early postoperative pain and some disadvantages in postoperative complications and costs.     

内痔粘膜及血管上皮细胞VEGF/FGF2的表达与内痔分期的相关性分析

目的 通过观察人体内痔不同分期粘膜及血管内皮细胞生长因子（VEGF）及碱性成纤维细胞生长因子（FGF2）的表达，探讨内痔的发生及发展机制。 方法 收集南方医院肛肠科门诊手术切除的Ⅰ、Ⅱ、Ⅲ期内痔标本134例（Ⅰ期42例，Ⅱ期45例，Ⅲ期47例），内痔周围正常肠壁组织40例作为对照，采用HE染色观察组织的病理学变化，采用免疫组织化学方法检测血管内皮细胞VEGF及FGF2的表达。 结果 正常组及Ⅰ期内痔黏膜层被覆上皮完整，未见扩张血管；Ⅱ期内痔黏膜层被覆上皮破坏，黏膜肌层破坏，黏膜层内见新生血管；Ⅲ期内痔黏膜层被覆上皮破坏，见血管管壁增厚迂曲，管腔扩张；与正常粘膜成纤维细胞相比VEGF在粘膜层成纤维细胞表达水平明显升高，并随分期增高而增高（F=883.961，P<0.01），FGF2也存在相同表达（F=656.013，P<0.01）；与正常组相比VEGF在血管内皮细胞表达水平明显升高，并随分期增高而增高（F=776.561，P<0.01），FGF2在血管内皮细胞的表达水平存在相同趋势（F=1066.458，P＜0.01）。 结论 VEGF及FGF2在内痔的形成过程中具有促进血管内皮细胞和粘膜下成纤维细胞增生的作用，同时可作为内痔发生发展的分子标志物。     

影响吻合器痔上黏膜环切术疗效的因素及改进方法

目的探讨影响吻合器痔上黏膜环切术(PPH)疗效的因素及改进方法。方法使用美国强生一次性PPH吻合器或国产PPH吻合器对68例痔病患者进行PPH手术，在手术改进前后分别对每例黏膜环切的标本以及症状的改善进行测量及观察。结果方法改进前，标本宽度为0．5～2．6cm，术后痔核回缩率75％；方法改进后，标本宽度为3．0～3．5cm，术后痔核回缩率100％。结论影响PPH手术疗效的因素主要是肛垫的提升复位与肛垫的固定。通过改进方法克服不利因素，使环切黏膜的宽度达到要求，进而使肛垫提升复位并得以固定，痔核回缩效果满意。     

自研复方止血消炎软膏促进痔疮术后恢复疗效及安全性观察

目的:观察自主研发的复方止血消炎软膏促进痔疮术后恢复的临床疗效及安全性.方法:选取本院痔疮术后疼痛、创面水肿、出血患者100例,随机分为观察组和对照组,每组50例.两组均予术后常规护理.观察组外用复方止血消炎软膏,1次/d,连用10 d;对照组外用马应龙麝香痔疮膏,1次/d,连用10 d.观察和比较两组患者治疗后的疼痛...     

中医药治疗痔疮的研究概述

中医在痔疮的治疗上有着其独特的内服、外治方法,目前临床上中医外治法主要有注射、熏洗、坐浴、外敷等等。在治疗中,中医医家根据痔疮的病因病机进行辨证分型,针对不同类型的痔疮,多采用一种或多种疗法综合治疗,取得了较好疗效。     

自动痔疮套扎术联合LigaSure痔切除术治疗Ⅱ、Ⅲ度混合痔58例

目的 观察自动痔疮套扎术(RPH)联合LigaSure痔切除术治疗Ⅱ、Ⅲ度混合痔的临床疗效.方法 回顾性分析2017年12月至2018年12月顺德新容奇医院收治的Ⅱ、Ⅲ度混合痔病人120例,按照手术方法的不同,分为观察组(接受RPH术联合LigaSure痔切除术治疗)58例及对照组[接受吻合器痔上黏膜环切术(PPH)联...     

消痔灵注射液治疗内痔出血疗效观察

目的 评价消痔灵注射液治疗内痔出血的临床疗效.方法 80例内痔出血患者经口服泻药或者灌肠,排便后自腔缘3、6、9点注入麻醉药,观察应用消痔灵注射液治疗80例内痔出血患者的疗效进行回顾性分析.结果 80例内痔出血患者中76例次日出血停止,4例便后偶有滴血症状,经局部换药、使用痔疮栓及局部熏洗等保守治疗后出血消失,随访6～24个月无复发.结论 消痔灵注射液治疗内痔出血是一种简单、有效、可靠的方法.

Abstract：

Objective To assess the clinical effect and safety of Xiaozhiling injection on bleeding caused by hemorrhoids.Methods A retrospective analysis was performed on 80 hemorrhoid patients treated with Xiaozhiling injection.Results Among 80 patients.76 bleeding stopped after the injection.Four bleeding had interrupted outbreak and was cured after symptomatic treatment.Conclusion Xiaozhiling is an effective medicine for treatment of hemorrhoids bleeding.     

基层医院痔疮患者应用PPH技术的安全性探讨

目的：通过对比探讨基层医院痔疮患者应用PPH技术的安全性。方法选取湖北省黄石市黄石港社区卫生服务中心2008年1月～2012年12月收治的110例痔疮患者,随机均分为观察组（A组）与对照组（B组）,观察组采用PPH术加外痔痔核切除术,对照组采用传统开放式手术。对2组患者的手术持续时间和术后恢复时间进行记录和对比,同时比较2组患者术后并发症的发生情况,包括肛门失禁、肛门狭窄、出血、感染、尿潴留等等。结果经过治疗,观察组（A组）手术平均时间为（21.3±5.7）min,对照组（B组）手术平均时间为（44.3±7.2）min,2组在手术平均时间上差异有统计学意义（P〈0.05）;在住院时间上,观察组（A组）平均（3.5±1.5）d,对照组（B组）（9.5±4.0）d,2组差异有统计学意义（P〈0.05）,并发症情况上,观察组（A组）在肛门狭窄、出血、感染、尿潴留方面显著强于对照组（B组）（P〈0.05）。结论基层医院PPH技术的安全性是优于传统开放式手术的,但仍存在一定问题有待进一步改进。