Effect of High Suspension and Low Incision Surgery Based on Traditional Ligation of Chinese Medicine in Treatment of Mixed Haemorrhoids:A Multi-centre,Randomized,Single-Blind,Non-inferiority Clinical Trial

Objective:To observe the clinical effect of high suspension and low incision(HSLI)surgery on mixed haemorrhoids,compared with Milligan-Morgan haemorrhoidectomy.Methods:A multi-centre,randomized,singleblind,non-inferiority clinical trial was performed.Participants with mixed haemorrhoids from Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing Rectum Hospital,Air Force Medical Center of People's Liberation Army of China,and Puyang Hospital of Traditional Chinese Medicine were enrolled from September 2016 to March 2018.By using a blocked randomization scheme,participants were assigned to two groups.The experimental group was treated with HSLI,while the control group was treated with Milligan-Morgan haemorrhoidectomy.The primary outcome was the clinical effect evaluated at 12 weeks after operation.The secondary outcomes included the number of haemorrhoids treated during the operation,pain scores,use of analgesics,postoperative oedema,wound healing,incidence of anal stenosis,anorectal manometry after operation,as well as surgical duration,length of stay and total hospitalization expenses.A safety evaluation was also conducted.Results:In total,246 eligible participants were enrolled,with 123 cases in each group.There was no significant difference in the clinical effect between the two groups(100.00% vs.99.19%,P>0.05).Compared with the control group,the number of external haemorrhoids treated during the operation and the pain scores after operation were significantly reduced in the experimental group(P<0.05 or P<0.01);the patient number with wound healing at 2 weeks after operation and the functional length of anal canal at 12 weeks after operation were significantly increased in the experimental group(P<0.05).There was no significant difference in the incidence of anal stenosis,the numbers of patients using analgesics and patients with postoperative oedema between the two groups after operation(P>0.05).The surgical duration and length of stay in the experimental group were significantly longer than those in the control group,and the total hospitalization expense was significantly higher than that in the control group(all P<0.05).No adverse events were reported in either group during the whole trial or follow-up period.Conclusion:HSLI had the advantages of preserving the skin of anal canal completely,alleviating postsurgical pain and promoting rapid recovery after operation.(Registration No.Chi CTR1900022883).

腹腔镜全直肠系膜切除术与经肛全直肠系膜切除术治疗低位直肠癌临床效果对比

目的:探究腹腔镜全直肠系膜切除术(LapTME)与经肛全直肠系膜切除术(TaTME)治疗低位直肠癌的临床效果。方法:选取2017年1月-2021年12月在苏州市相城人民医院接受治疗的低位直肠癌患者84例,按照随机数字表法将患者分为LapTME组和TaTME组,各42例。TaTME组给予经肛全直肠系膜切除术,LapTME组给予腹腔镜全直肠系膜切除术。比较两组低位前切除综合征(LARS)评分、应激反应因子水平[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、手术时间、术中出血量、术后住院天数、远切缘长度、标本长度、淋巴结数量、首次下床时间、肠功能恢复时间及并发症发生情况。结果:术后1、2、3个月,TaTME组LARS评分均低于LapTME组,差异均有统计学意义(P<0.05)。TaTME组手术时间长于LapTME组,术中出血量少于LapTME组,术后住院天数短于LapTME组,差异均有统计学意义(P<0.05)。术后,两组CRP、TNF-α、IL-6均高于手术前,且TaTME组均低于LapTME组,差异均有统计学意义(P<0.05)。TaTME组远切缘长度和标本长度均长于LapTME组,差异均有统计学意义(P<0.05)。TaTME组清除淋巴结数量高于LapTME组,但差异无统计学意义(P>0.05)。TaTME组初次下床时间和肠功能恢复时间均短于LapTME组,差异均有统计学意义(P<0.05)。TaTME组并发症发生率低于LapTME组,但差异无统计学意义(P>0.05)。结论:TaTME对低位直肠癌患者进行手术,其安全性更高,能够改善患者肛门功能,减轻术后应激反应,促进术后恢复,有助于肠功能的恢复。

超低剂量纳洛酮对地佐辛治疗切口痛模型大鼠术后疼痛效能的影响

目的:观察超低剂量纳洛酮(<1μg/kg)对地佐辛镇痛作用的影响。方法:选择24只雄性SD大鼠,按照随机数字表法均分为生理盐水组、纳洛酮组、地佐辛组、地佐辛+纳洛酮组,每组6只,参照Brennan法建立大鼠切口痛模型,模拟临床患者手术后疼痛。分别于术后经尾静脉给予等体积生理盐水、纳洛酮(1 ng/kg)、地佐辛(1mg/kg)、地佐辛(1 mg/kg)+纳洛酮(1 ng/kg)。分别于术前1 d和术后2 h、1 d、3 d、5 d、7 d测量大鼠手术足机械缩足反应阈值(PWT),评价不同药物的镇痛效果。结果:术后2 h,与生理盐水组比较,纳洛酮组PWT值无显著差异(P> 0. 05),地佐辛组与地佐辛+纳洛酮组PWT值显著增高(P <0. 01);地佐辛+纳洛酮组PWT值明显高于地佐辛组(P <0. 01)。术后1、3、5、7 d 4组间PWT值差异无统计学意义(P> 0. 05);与术前相比,4组术后1 d、3 d PWT值明显降低(P <0. 01);术后5 d、7 d差异无统计学意义(P> 0. 05)。结论:超低剂量纳洛酮无镇痛作用,但与地佐辛联用,可以增强后者的镇痛作用。

传统角形瓣与龈沟内切口袋形瓣在下颌中低位阻生智齿拔除术中的应用效果

目的探讨传统角形瓣与龈沟内切口袋形瓣在下颌中低位阻生智齿拔除术中的应用效果。方法对新郑华信民生医院2020年3月至2022年3月收治的106例下颌中低位阻生智齿患者的临床资料进行回顾性分析,按治疗方法分为对照组(53例)和观察组(53例)。对照组接受传统角形瓣治疗,观察组接受龈沟内切口袋形瓣治疗。比较两组患者的围手术期间相关指标、术后并发症以及治疗满意度。结果观察组的术后出血量、牙槽窝完整性评分、疼痛程度评分、肿胀程度均小于对照组(P<0.05)。对照组患者的术后并发症发生率(18.87%)高于观察组(5.67%)(χ^(2)=4.296,P=0.038)。对照组患者的治疗满意度(79.25%)低于观察组(96.23%)(χ^(2)=7.102,P=0.008)。结论与传统角形瓣相比,龈沟内切口袋形瓣应用于下颌中低位阻生智齿拔除术中的临床效果更好,能够缓解患者临床症状,且术后并发症少,治疗满意度高。