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
AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinatio...AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinations from January 2013 to January2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way.We analyzed the ultrasonographic findings of these participants and evaluated the outcomes.Resected gradesⅢandⅣhemorrhoid tissues were pathologically examined.The concordance of ultrasonographic results with pathologyresults was assessed with the Cohen’s kappa coefficient.RESULTS All healthy volunteers and all patients had no particular complications related to sonography.There were no statistically significant differences between the participants regarding age(P=0.5919),gender(P=0.4183),and persistent symptoms(P>0.8692).All healthy control participants had nospecial findings.However,30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography.When gradesⅠandⅡhemorrhoids were analyzed,there were no significant differences between transrectal ultrasound(TRUS),transperianal ultrasound(TPUS),and transvaginal ultrasound(TVUS)(P>0.05).GradesⅢandⅣhemorrhoids revealed blood flow with different directions which could be observed as a"mosaic pattern".In patients with gradesⅢandⅣhemorrhoids,the number of patients with"mosaic pattern"as revealed by TRUS,TPUS and TVUS was 22,12,and 4,respectively.Patients with gradesⅢandⅣdisease presented with a pathologically abnormal cushion which usually appeared as a"mosaic pattern"in TPUS and an arteriovenous fistula in pathology.Subepithelial vessels of resected gradesⅢandⅣhemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina.Some parts of the Trietz’s muscle showed hypertrophy and distortion.Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues.After pathological results with arteriovenous fistulas were taken as the standard reference,we evaluated the compatibility between the two methods according to the Cohen’s kappa coefficiency calculation.The compatibility(Cohein kappa co-efficiency value)between"mosaic pattern"in the TPUS and arteriovenous fistula in pathology was very good(?=0.8939).When compared between different groups,TRUS presented the advantage that the mosaic pattern could be confirmed in more patients,especially for group A.There was a statistical difference when comparing group A with group B or C(P<0.05 for both).There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS(P<0.05).CONCLUSION Patients with gradesⅢandⅣhemorrhoids present with a pathologically abnormal cushion which usually appears as a"mosaic pattern"in sonography,which is in accord with an arteriovenous fistula in pathology.There are clearly different hemorrhoid structures shown by sonography."Mosaic pattern"may be a parameter for surgical indication of gradesⅢandⅣhemorrhoids.展开更多
AIM: To describe the anal cushion lifting(ACL) method with preliminary clinical results. METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed c...AIM: To describe the anal cushion lifting(ACL) method with preliminary clinical results. METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher's classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or theligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery. RESULTS: A total of 127 patients were enrolled. Their median age was 42(19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median followup period was 26(0-88) mo, and the median operative time was 15(4-30) min. After surgery, analgesics were used for a median period of three days(0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients' postoperative hospital stay was 7(2-13) d. A total of 10 complications(7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred. CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids.展开更多
AIM:To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients.METHODS:Seventy-six consecutive patients(33 men and 43 women) with a mean age of 44 years were include...AIM:To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients.METHODS:Seventy-six consecutive patients(33 men and 43 women) with a mean age of 44 years were included.They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third-and fourth-degree hemorrhoids and failure in conservative treatment for years.Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work.The speed-constant rectal lavage apparatus was prepared in our laboratory.The device could output a pulsed and speed-constant saline stream with a high pressure,which is capable of overcoming any rectal resistance change.The patients were divided into three groups,group A(< 900 mL),group B(900-1200 mL) and group C(> 1200 mL) according to the results of the preoperative liquid continence test.RESULTS:All the patients completed the study.The average number of hemorrhoidal masses excised was 2.4.Most patients presented with hemorrhoidal symptoms for more than one year,including a mean duration of incontinence of 5.2 years.The most common symptoms before surgery were anal bleeding(n = 55),prolapsed lesion(n = 34),anal pain(n = 12) and constipation(n = 17).There were grade Ⅲ hemorrhoids in 39(51.3%) patients,and grade Ⅳ in 37(48.7%) patients according to Goligher classification.Five patients had experienced hemorrhoid surgery at least once.Compared with postoperative results,the retained volume in the preoperative liquid continence test was higher in 40 patients,lower in 27 patients,and similar in the other 9 patients.The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL,and postoperative volume was slightly decreased(991.27 ± 42.77 mL),but there was no significant difference(P = 0.057).Difference was significant in the test value before and after hemorrhoidectomy in group A(858.24 ± 32.01 mL vs 574.18 ± 60.28 mL,P = 0.011),but no obvious difference was noted in group B or group C.There was no significant difference in Wexner score before and after operation(1.68 ± 0.13 vs 2.10 ± 0.17,P = 0.064).By further stratified analysis,there was significant difference before and 2 months after operation in group A(2.71 ± 0.30 vs 3.58 ± 0.40,P = 0.003).In contrast,there were no significant differences in group B or group C(1.89 ± 0.15 vs 2.11 ± 0.19,P = 0.179;0.98 ± 0.11 vs 1.34 ± 0.19,P = 0.123).CONCLUSION:There is no difference in the continence status of patients before and after Milligan-Morgan hemorrhoidectomy.However,patients with preoperative compromised continence may have further deterioration of their continence,hence Milligan-Morgan hemorrhoidectomy should be avoided in such patients.展开更多
随着肛垫滑动学说被广泛接受,痔上黏膜钉合术(procedure for prolapse and hemorrhoids,PPH)在世界各地得到广泛的应用.PPH的核心技术是通过环形切除痔核上方一圈黏膜,悬吊肛垫,恢复肛管黏膜正常解剖结构,阻断部分痔上部分血流供应,使...随着肛垫滑动学说被广泛接受,痔上黏膜钉合术(procedure for prolapse and hemorrhoids,PPH)在世界各地得到广泛的应用.PPH的核心技术是通过环形切除痔核上方一圈黏膜,悬吊肛垫,恢复肛管黏膜正常解剖结构,阻断部分痔上部分血流供应,使痔核逐渐萎缩.尽管PPH顺应现代快速康复的微创化理念,且短期疗效显著(出血少、术后痛苦轻和恢复快),并有望成为"一日手术".但随后更多的回顾性研究和荟萃分析表明,与传统手术相比,仍存在一些不足,例如费用较高,远期复发率较高等.本文主要就PPH在临床的应用现状、术后并发症和相应对策进行相关探讨,以便为临床更好地应用PPH治疗痔病提供参考.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.
基金the National Natural Science Foundation of China,No.81460133Innovation Program of regional Cooperation of Xinjiang Uygur Autonomous region,No.2016E02063
文摘AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinations from January 2013 to January2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way.We analyzed the ultrasonographic findings of these participants and evaluated the outcomes.Resected gradesⅢandⅣhemorrhoid tissues were pathologically examined.The concordance of ultrasonographic results with pathologyresults was assessed with the Cohen’s kappa coefficient.RESULTS All healthy volunteers and all patients had no particular complications related to sonography.There were no statistically significant differences between the participants regarding age(P=0.5919),gender(P=0.4183),and persistent symptoms(P>0.8692).All healthy control participants had nospecial findings.However,30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography.When gradesⅠandⅡhemorrhoids were analyzed,there were no significant differences between transrectal ultrasound(TRUS),transperianal ultrasound(TPUS),and transvaginal ultrasound(TVUS)(P>0.05).GradesⅢandⅣhemorrhoids revealed blood flow with different directions which could be observed as a"mosaic pattern".In patients with gradesⅢandⅣhemorrhoids,the number of patients with"mosaic pattern"as revealed by TRUS,TPUS and TVUS was 22,12,and 4,respectively.Patients with gradesⅢandⅣdisease presented with a pathologically abnormal cushion which usually appeared as a"mosaic pattern"in TPUS and an arteriovenous fistula in pathology.Subepithelial vessels of resected gradesⅢandⅣhemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina.Some parts of the Trietz’s muscle showed hypertrophy and distortion.Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues.After pathological results with arteriovenous fistulas were taken as the standard reference,we evaluated the compatibility between the two methods according to the Cohen’s kappa coefficiency calculation.The compatibility(Cohein kappa co-efficiency value)between"mosaic pattern"in the TPUS and arteriovenous fistula in pathology was very good(?=0.8939).When compared between different groups,TRUS presented the advantage that the mosaic pattern could be confirmed in more patients,especially for group A.There was a statistical difference when comparing group A with group B or C(P<0.05 for both).There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS(P<0.05).CONCLUSION Patients with gradesⅢandⅣhemorrhoids present with a pathologically abnormal cushion which usually appears as a"mosaic pattern"in sonography,which is in accord with an arteriovenous fistula in pathology.There are clearly different hemorrhoid structures shown by sonography."Mosaic pattern"may be a parameter for surgical indication of gradesⅢandⅣhemorrhoids.
文摘AIM: To describe the anal cushion lifting(ACL) method with preliminary clinical results. METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher's classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or theligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery. RESULTS: A total of 127 patients were enrolled. Their median age was 42(19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median followup period was 26(0-88) mo, and the median operative time was 15(4-30) min. After surgery, analgesics were used for a median period of three days(0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients' postoperative hospital stay was 7(2-13) d. A total of 10 complications(7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred. CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids.
文摘AIM:To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients.METHODS:Seventy-six consecutive patients(33 men and 43 women) with a mean age of 44 years were included.They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third-and fourth-degree hemorrhoids and failure in conservative treatment for years.Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work.The speed-constant rectal lavage apparatus was prepared in our laboratory.The device could output a pulsed and speed-constant saline stream with a high pressure,which is capable of overcoming any rectal resistance change.The patients were divided into three groups,group A(< 900 mL),group B(900-1200 mL) and group C(> 1200 mL) according to the results of the preoperative liquid continence test.RESULTS:All the patients completed the study.The average number of hemorrhoidal masses excised was 2.4.Most patients presented with hemorrhoidal symptoms for more than one year,including a mean duration of incontinence of 5.2 years.The most common symptoms before surgery were anal bleeding(n = 55),prolapsed lesion(n = 34),anal pain(n = 12) and constipation(n = 17).There were grade Ⅲ hemorrhoids in 39(51.3%) patients,and grade Ⅳ in 37(48.7%) patients according to Goligher classification.Five patients had experienced hemorrhoid surgery at least once.Compared with postoperative results,the retained volume in the preoperative liquid continence test was higher in 40 patients,lower in 27 patients,and similar in the other 9 patients.The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL,and postoperative volume was slightly decreased(991.27 ± 42.77 mL),but there was no significant difference(P = 0.057).Difference was significant in the test value before and after hemorrhoidectomy in group A(858.24 ± 32.01 mL vs 574.18 ± 60.28 mL,P = 0.011),but no obvious difference was noted in group B or group C.There was no significant difference in Wexner score before and after operation(1.68 ± 0.13 vs 2.10 ± 0.17,P = 0.064).By further stratified analysis,there was significant difference before and 2 months after operation in group A(2.71 ± 0.30 vs 3.58 ± 0.40,P = 0.003).In contrast,there were no significant differences in group B or group C(1.89 ± 0.15 vs 2.11 ± 0.19,P = 0.179;0.98 ± 0.11 vs 1.34 ± 0.19,P = 0.123).CONCLUSION:There is no difference in the continence status of patients before and after Milligan-Morgan hemorrhoidectomy.However,patients with preoperative compromised continence may have further deterioration of their continence,hence Milligan-Morgan hemorrhoidectomy should be avoided in such patients.
文摘随着肛垫滑动学说被广泛接受,痔上黏膜钉合术(procedure for prolapse and hemorrhoids,PPH)在世界各地得到广泛的应用.PPH的核心技术是通过环形切除痔核上方一圈黏膜,悬吊肛垫,恢复肛管黏膜正常解剖结构,阻断部分痔上部分血流供应,使痔核逐渐萎缩.尽管PPH顺应现代快速康复的微创化理念,且短期疗效显著(出血少、术后痛苦轻和恢复快),并有望成为"一日手术".但随后更多的回顾性研究和荟萃分析表明,与传统手术相比,仍存在一些不足,例如费用较高,远期复发率较高等.本文主要就PPH在临床的应用现状、术后并发症和相应对策进行相关探讨,以便为临床更好地应用PPH治疗痔病提供参考.
