Doppler-Guided Transanal Haemorrhoidal Dearterialisation is a Safe and Effective Daycase Procedure for All Grades of Symptomatic Haemorrhoids

Purpose: Doppler-guided transanal haemorrhoidal dearterialisation (THD), with the addition of rectal mucopexy, has been gaining popularity as a minimally invasive haemorrhoidal treatment. The aim of this study was to assess the outcomes of THD in patients with symptomatic haemorrhoids. Methods: All consecutive patients undergoing THD by a single surgeon over a 2 year period from 1st January 2010 were included. Results: THD was performed on 58 consecutive patients, with 46 (79.3%) having had previous haemorrhoidal treatment(s). Haemorrhoid grades were: 1 (n = 6);2 (n = 12);3 (n = 32);4 (n = 8). The median number of THD ligations was 7 (range 4 to 9) and rectal mucopexies 3 (range 1 to 3). All procedures (100%) were carried out as daycase, with 1 readmission within 30 days (anal fissure). No patients required return to theatre. After median follow-up of 10.5 weeks (range 1 to 48 weeks, 2 lost to follow-up), 53 (91%) patients reported symptomatic resolution or significant improvement. Two (3.4%) patients had post-operative complications (anal fissure). Two (3.4%) patients had further haemorrhoidal surgery following THD. Conclusions: THD is a safe daycase procedure for symptomatic haemorrhoids of all grades. It is an effective treatment in the short term, but longer-term follow-up is required to assess its symptomatic benefit more formally.

Vascular Z-shaped ligation technique in surgical treatment of haemorrhoid

AIM: To present the effectiveness of minimal invasive vascular zet ligation in the surgical treatment of haemorrhoidal disease(HD).METHODS: Among 138 patients with 2nd-4th grade internal HD having several complaints and operated at our hospital between 2003-2013; 116 patients who regularly attended 1-year control were included in the study. Operation times, postoperative early period pain, satisfaction score, complications and relapse details were obtained from computer records retrospectively. Visual Analogous Scale(VAS) scores were used for patient satisfaction on the 3rd, 7th and 21 st days. Technique; fixed suture which is constituted by the first leg of the Z-shaped suture(to pass by the mucosa and muscular layer) was put in the pile root in order to ensure vascular ligation and fixation. The second leg of the Z-shaped suture is constituted by mobile suture and it passes by the pile mucosa and submucosa which prolapses 5-10 mm below the first suture. RESULTS: Seventy-five of the patients(65%) were male, 41 of them(35%) were female and their age average was 41. The mean operation time was 12 ± 4.8 min. VAS/satisfaction score was found as 2.2/4.3, 1.8/4.0, 1.2/4.4 respectively on the 3rd, 7th, and 21 st days. Four of the patient(3.5%) had relapse.CONCLUSION: This technique is an easily applicable, cost efficient way of operation which increases patient satisfaction.

Comparison of a modified anoscope and the purse-string anoscope in stapled haemorrhoidopexy

AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.

How we can improve patients’comfort after Milligan- Morgan open haemorrhoidectomy

AIM:To demonstrate the value of Diosmin(flavonidic fraction)in the management of post-haemorhoidectomic symptoms.METHODS:Eighty-six consecutive patients with grades ⅢandⅣacute mixed hemorrhoids admitted to the Anorectal Surgical Department of First Affiliated Hospital,Xinjiang Medical University from April 2009 to April 2010,were enrolled in this study.An observerblinded,randomized trial was conducted to compare post-haemorhoidectomic symptoms with use of Diosmin flavonidic fraction vs placebo.Eighty-six patients were randomly allocated to receive Diosmin flavonidic fraction 500 mg for 1 wk(n=43)or placebo(n=43).The Milligan-Morgan open haemorrhoidectomy was performed by a standardized diathermy excision method.Pain,bleeding,heaviness,pruritus,wound edema and mucosal discharge were observed after surgery.The postoperative symptoms and hospitalization time were recorded.RESULTS:The mean age of the Diosmin group and controls was 53.2 and 51.3 years,respectively.In Diosmin group,haemorrhoid piles were of the third degree in 33 patients and the fourth degree in 10;and in the control group,29 were of the third degree and 14 were of the fourth degree.There was no statistically significance in age,gender distribution,degree and number of excised haemorrhoid piles,and the mean duration of haemorrhoidal disease between the two groups.There was a statistically significant improvement in pain,heaviness,bleeding,pruritus from baseline to the 8th week after operation(P<0.05).Patients taking Diosmin had a shorter hospitalization stay after surgery(P< 0.05).There was also a significant improvement on the proctoscopic appearance(P<0.001).However,there was no statistical difference between the two groups in terms of wound mucosal discharge.Two patients experienced minor bleeding at the 8th week in Diosmin group,and underwent surgery.CONCLUSION:Diosmin is effective in alleviating postoperational symptoms of haemorrhoids.Therefore,it should be considered for the initial treatment after haemorrhoid surgery.However,further prospective randomized trials are needed to confirm the findings of this study.

The Haemorrhoids’ Pathology: Epidemiological, Diagnostic, Therapeutic and Evolutionary Aspects

Background: Hemorrhoidal disease is most frequently encountered in proctology affection;it is defined by signs or symptoms attributed to hemorrhoids. Its pathogenesis is based on old theories and vascular mechanical which are nevertheless based on the current therapeutic approach. General Aim of the Study: To study haemorrhoids’ pathology in order to improve its management. Methodology: A retrospective cross-sectional study was conducted over a period of two (2) years from 1 January 2012 to 31 December 2013. Data were collected from outpatients records in hepato-gastroenterology and digestive surgery services at “Polyclinique Notre Dame de la Paix” in Ouagadougou (2294 files). Results: 140 cases of haemorrhoids were recorded during our study period. The frequency was 6.1% of consultations. Males predominated with 75.71% of patients (sex ratio = 3.12). The average age was 39.58 years. Civil servants were most affected by this disease (60%). Rectal bleeding was the most common reason of consultation (52.14%). The crown shape was predominated (59%). The frequency of external haemorrhoids was the highest (65.71%) and stage 4 (40.79%) was the most represented. Anal fissure was the proctologic pathology, the most associated to haemorrhoids (17.14%). Medical treatment concerned 89.28% of patients with 69.6% of favorable short-term evolution. No instrumental treatment was performed. Surgical treatment consisted of 10.71% of patients and the technique used was the Milligan-Morgan performed under spinal anesthesia. The postoperative complications were mainly represented by anal intense pain and acute urinary retention. The healing period of wounds was on average 6 weeks. Conclusion: The hemorrhoid has often underestimated in our regions. The instrumental treatment is nonexistent and should take an important place;it must be an indication before surgery.

Haemorrhoidal Disease in Cotonou: Epidemiological, Clinical and Anuscopic Aspects

The haemorrhoidal disease is a very common disorder in proctology. It is favoured by many factors. Although benign, its treatment is difficult. Our aim is to study the epidemiological, clinical and anuscopic of haemorrhoidal disease. This was a cross sectional, descriptive and prospective study covering a three-month period from 06 January 2014 to 10 April 2014. It involved patients seen in gastroenterology consultation in internal medicine of the National Teaching Hospital of Cotonou and in the digestive diseases Unit of the Hospital of Menontin. We recorded 182 patients including 57 cases of haemorrhoidal disease, a prevalence of 31.3%. The sex ratio was 1.10. The average age was 43 years with extremes of 18 and 88 years. Anal events were dominated by rectal bleeding (54.4%) with a predominance of internal haemorrhoidal disease (87.7%). Stage 2 evolution of the disease was the most represented (65.4%). Haemorrhoidal disease is a common disorder seen mainly in actively producing people (young adult) with a male predominance.

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).

Fatal necrotizing fasciitis following sclerotherapy for haemorrhoids

A 58-year-old male was admitted with a history of rectal bleeding of 6 months duration. He had no otherwise significant past medical or surgical history. After admitting, he was diagnosed with second degree haemorrhoids with bleeding. Three internal haemorrhoids were rejected subnnmosally with 5% phenol. About 5 hours following rejection, during night ward rounds, he was found pain in perineuln and lower abdomen, for which pethidine was given to him.

混合痔手术围手术期护理观察

目的回顾性分析混合痔手术患者围手术期护理经验。方法收集40例行手术治疗的混合痔患者的临床资料,总结归纳术前准备、术中配合和术后专科护理、并发症预防和治疗方法。结果本组患者中,术后4h内排尿者31例,6例患者通过给予神经反射诱导成功排尿,2例患者给予肌注新斯的明配合针刺治疗后成功排尿,1例患者行导尿术协助排尿。。术后随访3个月未发生患者复发及创面假愈合情况。结论混合痔手术根据病因和适应证选择适宜的手术方案,配合充分的术前准备、密切的术中护理配合以及精准的术后综合护理干预,有助于减轻患者痛苦,预防相关并发症,促进早期恢复。

揿针联合电针治疗气滞血瘀型痔病术后疼痛的临床观察

【目的】观察揿针联合电针治疗气滞血瘀型痔病术后疼痛的临床疗效。【方法】将150例气滞血瘀型痔病术后疼痛患者随机分为观察组、对照组和常规组,每组各50例,常规组给予常规消炎与支持治疗,对照组在常规组治疗的基础上,给予揿针治疗,观察组在对照组治疗的基础上,给予电针治疗。共治疗6 d。治疗6 d后,评价3组临床疗效,观察3组患者治疗前后视觉模拟疼痛量表(VAS)评分的变化情况,比较3组患者治疗前后5-羟色胺(5-HT)、降钙素相关基因肽(CGRP)、去甲肾上腺素(NE)、P物质(SP)、β-内啡肽(β-EP)含量的变化情况。【结果】(1)观察组显效率为36.00%(18/50),对照组为14.00%(7/50),常规组为4.00%(2/50)。观察组显效率明显优于对照组与常规组,差异有统计学意义(P<0.05)。观察组总有效率为100.00%(50/50),对照组为100.00%(50/50),常规组为96.00%(48/50)。观察组与对照组、常规组比较,差异无统计学意义(P>0.05)。(2)治疗后6、12、24、48 h,3组患者的VAS疼痛评分均明显改善(P<0.05),且观察组在改善VAS疼痛评分方面明显优于对照组和常规组,差异有统计学意义(P<0.05)。(3)治疗后,3组患者的血清NE、5-HT、CGRP、SP、β-EP水平均明显改善(P<0.05),且观察组在改善血清NE、5-HT、CGRP、SP、β-EP水平方面明显优于对照组和常规组,差异均有统计学意义(P<0.05)。【结论】揿针联合电针治疗气滞血瘀型痔病术后疼痛,能明显改善患者的疼痛症状,患者血清5-HT、CGRP、NE、SP、β-EP水平均有明显改善,疗效显著。

基于循证依据的快速康复护理方案在痔疮手术患者中的应用

目的 探讨基于循证依据的快速康复外科(fast track surgery,FTS)护理方案在痔疮手术患者中的应用价值。方法 方便选取2023年1—12月南华大学附属第二医院收治的92例痔疮手术患者为研究对象,根据不同护理方法分为对照组和观察组,各46例。对照组行常规护理,观察组行基于循证依据的FTS护理方案,比较两组患者的并发症发生情况、负面情绪及护理满意度。结果 观察组肛缘水肿、尿潴留、感染、便秘等并发症的总发生率为4.35%(2/46),高于对照组的21.74%(10/46),差异有统计学意义(χ^(2)=6.133,P=0.013)。观察组焦虑情绪评分、抑郁情绪评分均低于对照组,护理满意度高于对照组,差异有统计学意义(P均<0.05)。结论 对痔疮手术患者采用基于循证依据的FTS护理方案,可减少肛缘水肿、感染等并发症的发生风险,减轻患者的负面情绪,提升患者对护理服务质量的满意度评价。

基于循证理念的个性化护理干预在混合痔患者术后康复中的应用效果

目的:探讨基于循证理念的个性化护理干预在混合痔患者术后康复中的应用效果.方法:选取2021年6月至2023年6月本院收治的151例混合痔患者为研究对象.根据干预方案,将其分为观察组(n=77,给予基于循证理念的个性化护理干预)和对照组(n=74,给予常规护理干预).比较两组患者康复进程情况、焦虑自评表(SAS)评分、抑郁自评表(SDS)评分及疼痛数字评分法(NRS)评分.结果:护理后,观察组患者肛门排气时间、腹胀持续时间、下床活动时间均短于对照组,差异均有统计学意义(P<0.05);观察组患者SAS、SDS评分均低于对照组,差异均有统计学意义(P<0.05);观察组患者NRS评分低于对照组,差异有统计学意义(P<0.05).结论:在混合痔患者术后康复进程中给予基于循证理念的个性化护理干预,可有效减轻其疼痛感,改善心理状态,加快病情康复.

陆金根治疗痔出血的临床经验

介绍陆金根教授治疗痔出血的临床经验。认为痔出血多由湿热下注、热盛迫血妄行引起,治疗以凉血清热燥湿为主,总结为4法,即凉血止血治其标、活血散瘀绝后患、清热燥湿澄其源、补益虚损固其本。并附验案1则。

吻合器痔环切术与传统痔切除术临床对照研究

目的 比较吻合器痔环切术(PPH)与传统痔切除术(Milligan Morgan)治疗脱垂性内痔、混合痔的临床疗效。方法 将2 0 0例脱垂性内痔、混合痔患者随机分为PPH组和Milli gan Morgan组并采用相应术式进行手术,观察2种手术方法的手术时间、术中出血量、术后疼痛、住院时间等指标。结果 PPH法在手术时间、术中出血量、术后疼痛、住院时间等方面优于Milligan Morgan法,具有显著性差异。结论 PPH法在治疗脱垂性内痔、混合痔方面优于传统痔切除术。

直肠前壁修补联合痔上黏膜环切术治疗女性直肠前突引起的出口梗阻型便秘的临床效果评价

目的:研究直肠前壁修补联合痔上黏膜环切术(PPH)治疗女性直肠前突引起的出口梗阻型便秘的临床价值。方法:将2004—2008年在本院诊断并符合手术指征的女性直肠前突患者随机分为单纯直肠前壁修补和直肠前壁修补加PPH两组,分别观察其有效率和Longo’sODS评分。结果:直肠前壁修补组总有效率为87.71%,直肠前壁修补加PPH组总有效率为97.5%,二者比较差异有显著性(P<0.01);直肠前壁修补术组Longo’sODS评分由术前的17.34±2.77降至6.31±1.31,直肠前壁修补加PPH组Longo’sODS评分由术前的17.25±2.81降至5.39±1.62,两组患者术后生活质量均有改善,但直肠前壁修补联合PPH效果明显优于单纯直肠前突修补术(P<0.01);两组患者均无严重手术并发症。结论:直肠前壁修补联合PPH是治疗女性直肠前突引起的出口梗阻型便秘的安全有效方法,优于单纯直肠前壁修补术。

痔上黏膜套扎术结合痔核剥切技术在治疗高龄患者Ⅲ～Ⅳ度混合痔中的临床价值

目的评价痔上黏膜套扎术结合痔核剥切技术在治疗高龄中重度混合痔患者的临床价值。方法选择2011年5月-2013年12月北京中医药大学附属护国寺中医医院外科收治的166例高龄Ⅲ-Ⅳ度混合痔患者,根据随机数字表法分为A组（57例）、B组（54例）和C组（55例）。A组采用痔上黏膜套扎术配合痔核剥切技术,B组行传统混合痔外切内扎技术,C组行吻合器痔上黏膜环切吻合术结合痔核剥切技术。记录并比较三组患者在的手术操作时间、临床疗效、术后并发症、住院时间、住院费用和术后12个月复发率的结果。结果三组患者在术后疼痛和出血积分比较,差异有统计学意义（P〈0.05）,且A组优于B组和C组,差异有统计学意义（P〈0.05）。三组患者的术后并发症发生率比较,差异有统计学意义（P〈0.05）,且A组（7.0%）低于B组（27.6%）和C组（15.8%）,差异有统计学意义（P〈0.05）。三组患者的手术住院时间比较,差异有统计学意义（P〈0.05）,且A组[（7.42±2.01）d]少于B组[（12.45±2.18）d]和C组[（10.28±2.36）d],差异有统计学意义（P〈0.05）。三组患者住院费用比较,差异有统计学意义（P〈0.05）,且A组[（3560.06±201.37）元]少于C组[（5634.17±276.68）元],差异有统计学意义（P〈0.05）。三组患者的术后12个月复发率比较,差异有统计学意义（P〈0.05）,且A组（3.5%）少于B组（14.8%）和C组（10.9%）,差异有统计学意义（P〈0.05）。结论痔上黏膜套扎术结合痔核剥切技术对于高龄中、重度痔疮患者的治疗,具有损伤小、术后并发症少、住院时间短、治疗费用少、复发率低等优点,是一种微创、安全、有效、经济的方法。

痔科外洗方对肛瘘创面修复TβR-β1、TGF-β1mRNA表达的影响

[目的]探讨痔科外洗方对肛瘘创面修复的作用机理。[方法]采用动物模型,运用实时荧光定量PCR方法动态观测大鼠肉芽组织的TGF-β1水平及TGF-β1mRNA表达水平的影响,并与高锰酸钾作比较。[结果]痔科外洗方可明显提高TGF-β1水平,对TGF-β1mRNA表达有良好的调控作用,功效优于高锰酸钾。[结论]痔科外洗方对TGF-β1mRNA的良好调控作用是其对肛瘘创面的修复作用的重要机理。

结肠镜下硬化注射法治疗内痔临床效果评价

目的观察和比较结肠镜下内痔硬化注射与痔上黏膜环切钉合术（PPH）对内痔治疗效果和费用。方法选择2009年5月一2012年5月广州医科大学附属第二医院收治Ⅲ度内痔患者109例，分为结肠镜下硬化注射组79例和痔上黏膜环切钉合术组30例，结肠镜下硬化注射组患者给予结肠镜下硬化剂注射治疗，痔上黏膜环切钉合术组患者给予PPH手术治疗。观察比较两组临床疗效、并发症和费用等情况。结果①两组治疗时间、创面愈合时间、住院天数差异有统计学意义（P〈0．05）；两组治疗有效率差异无统计学意义（P〉0．05）。②两组治疗后肛门下坠感、继发出血和肛缘水肿发生率差异有统计学意义（P〈0．05），而切1：3感染和排尿困难发生率差异无统计学意义（P〉0．05）。结肠镜下硬化注射组单次治疗费用为（2536．0±57．8）元，而痔上黏膜环切钉合术组单次治疗费用为（9057．5±2169．0）元，差异有统计学意义（P〈0．05）。结论结肠镜下内痔硬化注射是内痔治疗的改良方法，可重复操作，治疗费用低，并发症极少，具有较好的疗效，值得广泛推广运用。

PPH结合痔切除与开放式外剥内扎术治疗环状混合痔的对比研究

目的:比较PPH结合痔切除与传统式手术治疗环状混合痔的临床效果。方法:对100例PPH手术与传统式手术组的结果进行分析比较。结果:通过对手术时间、疼痛指数、住院时间、恢复工作时间、患者的满意度、术后各种并发症的发生率及复发等进行比较研究,PPH组占有明显优势。结论:PPH结合痔切除术操作简单、安全可靠、出血少、疼痛轻、并发症少、恢复快,是治疗环状混合痔的首选术式。

马应龙麝香痔疮膏联合地奥司明片对混合痔术后创面水肿的防治效果

目的:探讨马应龙麝香痔疮膏联合地奥司明片对混合痔术后创面水肿的防治效果。方法:选取2015年10月至2017年10月德阳市人民医院收治的混合痔术后患者144例作为研究对象,随机分为对照组和观察组,每组72例。对照组患者给予迈之灵片口服治疗,观察组给予地奥司明片口服,马应龙麝香痔疮膏涂抹于肛门创面附近,2组均连续治疗7 d,随访6个月。比较2组患者临床疗效,评估2组患者术后创面疼痛、水肿恢复情况、肛门功能,检测并比较2组创面P物质(SP)含量。结果:治疗后观察组总有效率为95. 83%显著高于对照组的79. 17%(P <0. 01)。术后2～6 d,2组创面NRS评分和水肿评分逐渐降低(P <0. 01),且术后4 d、6 d观察组创面NRS评分和水肿评分低于对照组,疼痛和水肿缓解时间较对照组缩短(P <0. 01)。从出院至术后6个月,2组Wexner评分逐渐降低(P <0. 01),观察组出院时Wexner评分低于对照组(P <0. 01),术后3～6个月2组Wexner评分差异无统计学意义(P> 0. 05)。术后2～6 d,2组创面SP含量呈现逐渐升高趋势(P <0. 01),且观察组术后4 d、6 d创面SP含量明显高于对照组(P <0. 01)。结论:混合痔术后患者应用马应龙麝香痔疮膏联合地奥司明片治疗可加速创面疼痛及水肿的缓解,改善患者肛门功能,可能与增加创面组织中SP含量有关。