BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high incidence.The treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid prolapse.Although it ...BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high incidence.The treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid prolapse.Although it is related to less posoperative pain,faster recovery and shorter hospital stays,the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy(MMH).We have considered that recurrence could be due to shortage of the pulling-up effect.This issue may be overcome by using lower purse-string sutures[modified-PPH(M-PPH)].AIM To compare the therapeutic effects and the patients’satisfaction after M-PPH,PPH and MMH.METHODS This retrospective cohort study included 1163 patients(M-PPH,461;original PPH,321;MMH,381)with severe hemorrhoids(stage III/IV)who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014.Early postoperative complications,efficacy,postoperative anal dysfunction and patient satisfaction were compared among the three groups.Established criteria were used to assess short-and long-term postoperative complications.A visual analog scale was used to evaluate postoperative pain.Follow-up was conducted 5 years postoperatively.RESULT Length of hospital stay and operating time were significantly longer in the MMH group(8.05±2.50 d,19.98±4.21 min;P<0.0001)than in other groups.The incidence of postoperative anastomotic bleeding was significantly lower after MPPH than after PPH or MMH(1.9%,5.1%and 3.7%;n=9,16 and 14;respectively).There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH(15%,8%and 10%;n=69,30 and 32;respectively).There was a significantly lower rate of recurrence after M-PPH than after PPH(8.7%and 18.8%,n=40 and 61;P<0.0001).The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups(1.3%and 4.3%,n=5 and 20;P=0.04).Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSION M-PPH has many advantages for severe hemorrhoids(Goligher stage III/IV),with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.展开更多
With the application of the principle of PDCA, and dr awing on the experience of the process methods of the ISO9000 and the system met hods of management, the author analyses the basic requirement to fulfill quality m...With the application of the principle of PDCA, and dr awing on the experience of the process methods of the ISO9000 and the system met hods of management, the author analyses the basic requirement to fulfill quality management system in enterprises. Then the author inquires into the procedure t o establish the efficiency quality management system. Finally four stages (plan, do, check, action) and eight steps (decision, plan, analyze, design, do, check, improve, fulfill) are put forward to fulfill quality management system.展开更多
目的观察改良吻合器痔上粘膜环切术(Procedure for Prolapse and Hemorrhoids,PPH)治疗重度混合痔的有效性。方法回顾性分析近3年来该院应用吻合器痔上粘膜环切术治疗重度混合痔54例的术式演变与临床疗效。结果改良PPH不仅创伤小、疼痛...目的观察改良吻合器痔上粘膜环切术(Procedure for Prolapse and Hemorrhoids,PPH)治疗重度混合痔的有效性。方法回顾性分析近3年来该院应用吻合器痔上粘膜环切术治疗重度混合痔54例的术式演变与临床疗效。结果改良PPH不仅创伤小、疼痛轻、恢复快,且对控制出血、防止脱垂以及减少并发症的作用显著。患者满意率达96.3%。结论改良的吻合器痔上粘膜环切术可有效治疗重度混合痔。展开更多
文摘BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high incidence.The treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid prolapse.Although it is related to less posoperative pain,faster recovery and shorter hospital stays,the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy(MMH).We have considered that recurrence could be due to shortage of the pulling-up effect.This issue may be overcome by using lower purse-string sutures[modified-PPH(M-PPH)].AIM To compare the therapeutic effects and the patients’satisfaction after M-PPH,PPH and MMH.METHODS This retrospective cohort study included 1163 patients(M-PPH,461;original PPH,321;MMH,381)with severe hemorrhoids(stage III/IV)who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014.Early postoperative complications,efficacy,postoperative anal dysfunction and patient satisfaction were compared among the three groups.Established criteria were used to assess short-and long-term postoperative complications.A visual analog scale was used to evaluate postoperative pain.Follow-up was conducted 5 years postoperatively.RESULT Length of hospital stay and operating time were significantly longer in the MMH group(8.05±2.50 d,19.98±4.21 min;P<0.0001)than in other groups.The incidence of postoperative anastomotic bleeding was significantly lower after MPPH than after PPH or MMH(1.9%,5.1%and 3.7%;n=9,16 and 14;respectively).There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH(15%,8%and 10%;n=69,30 and 32;respectively).There was a significantly lower rate of recurrence after M-PPH than after PPH(8.7%and 18.8%,n=40 and 61;P<0.0001).The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups(1.3%and 4.3%,n=5 and 20;P=0.04).Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSION M-PPH has many advantages for severe hemorrhoids(Goligher stage III/IV),with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.
文摘With the application of the principle of PDCA, and dr awing on the experience of the process methods of the ISO9000 and the system met hods of management, the author analyses the basic requirement to fulfill quality management system in enterprises. Then the author inquires into the procedure t o establish the efficiency quality management system. Finally four stages (plan, do, check, action) and eight steps (decision, plan, analyze, design, do, check, improve, fulfill) are put forward to fulfill quality management system.
文摘目的观察改良吻合器痔上粘膜环切术(Procedure for Prolapse and Hemorrhoids,PPH)治疗重度混合痔的有效性。方法回顾性分析近3年来该院应用吻合器痔上粘膜环切术治疗重度混合痔54例的术式演变与临床疗效。结果改良PPH不仅创伤小、疼痛轻、恢复快,且对控制出血、防止脱垂以及减少并发症的作用显著。患者满意率达96.3%。结论改良的吻合器痔上粘膜环切术可有效治疗重度混合痔。
