AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they unde...AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.展开更多
目的观察外剥内扎术结合残余痔组织剥除、痔上黏膜套扎术(M-M procedure,excision of residual piles tissue and above mucosa ligation,MEAL)治疗环状混合痔的临床疗效。方法收集2019年1月至2020年1月于南京中医药大学第二附属医院肛...目的观察外剥内扎术结合残余痔组织剥除、痔上黏膜套扎术(M-M procedure,excision of residual piles tissue and above mucosa ligation,MEAL)治疗环状混合痔的临床疗效。方法收集2019年1月至2020年1月于南京中医药大学第二附属医院肛肠中心接受MEAL的54例环状混合痔病人作为实验组(MEAL组);以同期47例行单纯外剥内扎术(M-M组)和36例行选择性痔上黏膜切除术(TST组)的病人为对照组,分别比较各组病人的住院时间、创面愈合时间、皮赘残留、痔疮复发、肛门狭窄及肛门失禁情况。结果随访时间为(351.80±110.28)d,MEAL组的住院时间和对照组比较,差异无统计学意义(均P>0.05);MEAL组的创面愈合时间(11.55±1.67)d短于M-M组(12.38±1.91)d及TST组(12.38±2.11)d,均差异有统计学意义(均P<0.05);MEAL组的痔疮复发率1.85%(1/54)、皮赘残留发生率18.52%(10/54)均低于M-M组痔疮复发率14.89%(7/47)、皮赘残留发生率36.17%(17/47)及TST组痔疮复发率16.66%(6/36)、皮赘残留发生率41.67%(15/36),差异有统计学意义(均P<0.05);全组均无肛门失禁及肛门狭窄病例。结论基于M-M的MEAL治疗环状混合痔具有减少创面、降低复发率等优点,在保护肛门的同时,明显减少了皮赘残留的发生。展开更多
BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in ...BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.展开更多
目的探讨Milligan-Morgan改良手术与吻合器痔切除术(procedure for prolapse and hemorrhoids,PPH)在混合痔治疗中的应用价值。方法收集50例分别接受了Milligan法和PPH手术进行治疗的Ⅱ～Ⅳ度混合痔患者,对两种术式疗效、手术时间、术...目的探讨Milligan-Morgan改良手术与吻合器痔切除术(procedure for prolapse and hemorrhoids,PPH)在混合痔治疗中的应用价值。方法收集50例分别接受了Milligan法和PPH手术进行治疗的Ⅱ～Ⅳ度混合痔患者,对两种术式疗效、手术时间、术后恢复时间、并发症等进行比较分析。结果与Milligan手术方式相比,PPH手术方式可明显缩短手术时间和住院时间、减少术后肛周疼痛,但费用较高,且对于脱垂的外痔皮赘治疗效果欠佳。结论PPH与Milligan-Morgan改良手术各有优劣,应当针对不同病人慎重选择、互为补充。展开更多
文摘AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.
文摘目的观察外剥内扎术结合残余痔组织剥除、痔上黏膜套扎术(M-M procedure,excision of residual piles tissue and above mucosa ligation,MEAL)治疗环状混合痔的临床疗效。方法收集2019年1月至2020年1月于南京中医药大学第二附属医院肛肠中心接受MEAL的54例环状混合痔病人作为实验组(MEAL组);以同期47例行单纯外剥内扎术(M-M组)和36例行选择性痔上黏膜切除术(TST组)的病人为对照组,分别比较各组病人的住院时间、创面愈合时间、皮赘残留、痔疮复发、肛门狭窄及肛门失禁情况。结果随访时间为(351.80±110.28)d,MEAL组的住院时间和对照组比较,差异无统计学意义(均P>0.05);MEAL组的创面愈合时间(11.55±1.67)d短于M-M组(12.38±1.91)d及TST组(12.38±2.11)d,均差异有统计学意义(均P<0.05);MEAL组的痔疮复发率1.85%(1/54)、皮赘残留发生率18.52%(10/54)均低于M-M组痔疮复发率14.89%(7/47)、皮赘残留发生率36.17%(17/47)及TST组痔疮复发率16.66%(6/36)、皮赘残留发生率41.67%(15/36),差异有统计学意义(均P<0.05);全组均无肛门失禁及肛门狭窄病例。结论基于M-M的MEAL治疗环状混合痔具有减少创面、降低复发率等优点,在保护肛门的同时,明显减少了皮赘残留的发生。
文摘BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.
文摘目的探讨Milligan-Morgan改良手术与吻合器痔切除术(procedure for prolapse and hemorrhoids,PPH)在混合痔治疗中的应用价值。方法收集50例分别接受了Milligan法和PPH手术进行治疗的Ⅱ～Ⅳ度混合痔患者,对两种术式疗效、手术时间、术后恢复时间、并发症等进行比较分析。结果与Milligan手术方式相比,PPH手术方式可明显缩短手术时间和住院时间、减少术后肛周疼痛,但费用较高,且对于脱垂的外痔皮赘治疗效果欠佳。结论PPH与Milligan-Morgan改良手术各有优劣,应当针对不同病人慎重选择、互为补充。
