AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obs...AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.展开更多
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
Objective:To summarize the experience without hemorrhage after PPH of 218 patients with mixed hemorrhoid.Methods:PPH(Procedure for prolapse and hemorrhoids)was performed routinely.During operation,it is paid attention...Objective:To summarize the experience without hemorrhage after PPH of 218 patients with mixed hemorrhoid.Methods:PPH(Procedure for prolapse and hemorrhoids)was performed routinely.During operation,it is paid attention that the hemorrhoid artery should be completely mutilated,the anastomat should be squeezed before and after the anastomosis,the anastomosis should be carefully examined,the hemostasis should be completely performed,and relevant hemostasis measures should be taken after the operation.Results:None of the 218 patients had postoperative hemorrhage.Conclusion:Relevant measures can be taken after operation to prevent the occurrence of postoperative hemorrhage.展开更多
目的探讨痔上黏膜环形切除订合术(procedure for prolapsed and hemorrhoids,PPH)加外痔切除术的临床疗效。方法治疗组48例采用PPH加外痔切除术,对照组48例采用外剥内扎术。结果治疗组手术时间、术后各合并症评分少于对照组,两组比较差...目的探讨痔上黏膜环形切除订合术(procedure for prolapsed and hemorrhoids,PPH)加外痔切除术的临床疗效。方法治疗组48例采用PPH加外痔切除术,对照组48例采用外剥内扎术。结果治疗组手术时间、术后各合并症评分少于对照组,两组比较差异有统计学意义(P<0.05);治疗组手术疗效与对照组比较,差异无统计学意义(P>0.05);治疗组住院费用多于对照组,差异有统计学意义(P<0.05)。结论 PPH加外痔切除术临床疗效显著。展开更多
目的:比较三种不同的吻合器痔上粘膜环形切除钉合术(procedure for prolapse andhaemorrhoids,PPH)手术的荷包缝合法及效果。方法:采用单荷包单圈缝合法(A组)、双荷包双圈缝合法(B组)以及双半荷包单圈缝合法(C组),对120例Ⅲ、Ⅳ度环状...目的:比较三种不同的吻合器痔上粘膜环形切除钉合术(procedure for prolapse andhaemorrhoids,PPH)手术的荷包缝合法及效果。方法:采用单荷包单圈缝合法(A组)、双荷包双圈缝合法(B组)以及双半荷包单圈缝合法(C组),对120例Ⅲ、Ⅳ度环状脱垂性内痔行PPH术,比较分析三组病例的手术时间、术中下腹部疼痛、切除直肠粘膜宽度、粘膜环完整性及均匀度、痔核回缩、吻合口部位、术中出血、痔核回缩度、术后肛门疼痛、术后出血及住院时间。结果:双半荷包单圈缝合后切除的直肠粘膜宽度cm、粘膜环完整性及均匀度、痔核回缩与双荷包双圈缝合法无显著性差异,优于单荷包单圈缝合法(P<0.05);双半荷包单圈缝合法及单荷包单圈缝合法手术时间较双荷包双圈缝合法时间缩短(P<0.05);术后肛门疼痛、术后出血及住院时间三组无显著性差异(P>0.05)。结论:双半荷包单圈缝合法能保证PPH手术切除直肠粘膜宽度、粘膜环完整性及均匀度、痔核回缩明显,且不增加手术程序及手术时间、具有一定的临床推广价值。展开更多
目的:本研究通过对直肠内脱垂伴环状混合痔所致出口梗阻性便秘两种不同术式的近期、远期的临床疗效观察及直肠测压对两种不同术式术前和术后肛门功能客观评价,探索该类型便秘的更好治疗方法.方法:对2010-01/2012-12就诊并接受住院治疗的...目的:本研究通过对直肠内脱垂伴环状混合痔所致出口梗阻性便秘两种不同术式的近期、远期的临床疗效观察及直肠测压对两种不同术式术前和术后肛门功能客观评价,探索该类型便秘的更好治疗方法.方法:对2010-01/2012-12就诊并接受住院治疗的120例直肠内脱垂伴环状混合痔患者,采用随机区组分组方法分为两组,试验组[吻合器痔上黏膜环切术(procedure forprolapse and hemorrhoids,PPH)],对照组(传统术式,即混合痔外剥内扎+直肠黏膜套扎),两组术前术后分别进行直肠肛门压力检测,分析两组患者手术前后肛门功能指标的肛肠压力变化和便秘患者生活质量评价表(The Patient Assessment of Constipation Quality of Life,PAC-QOL).结果:直肠肛门测压研究中,两组手术后的直肠肛门检测出现不同程度的减弱.试验组患者的术前与术后各项直肠肛门测压指标差异无统计学意义(P>0.05),表明吻合器痔上黏膜环切术没有对患者的肛门功能造成影响,不改变正常肛门功能,对照组患者的术前与术后除直肠静息压外,各项肛门直肠测压指标差异有统计学意义(P<0.05).试验组和对照组术前术后差异比较,除直肠静息压外均有统计学意义(P<0.05),表明传统术式对正常的肛门功能造成了一定影响.两组患者手术后进行跟踪随访,通过应用生活质量量表的评价,PPH手术与传统手术相比各维度及总分的差异均有统计学意义,PPH术式组表现较好的生活质量.结论:采用PPH手术方式解决直肠内脱垂同时伴环状混合痔所致出口梗阻性便秘,跟传统术式(混合痔外剥内扎术+直肠黏膜套扎术)作比较,临床疗效优于后者,而且前者表现出较高的生活质量,值得临床上推广.展开更多
目的：研究吻合器痔上粘膜环切术（procedure for prolapse and hemorrhoids,PPH）吻合器击发位置对内痔疗效及并发症的影响。方法：收集汕头大学医学院第一附属医院2004年至2009年的198例内痔患者,随机分成3组,并通过比较3组志愿者PPH...目的：研究吻合器痔上粘膜环切术（procedure for prolapse and hemorrhoids,PPH）吻合器击发位置对内痔疗效及并发症的影响。方法：收集汕头大学医学院第一附属医院2004年至2009年的198例内痔患者,随机分成3组,并通过比较3组志愿者PPH吻合器分别在齿状线以上1.5cm、2.5cm、3.0cm三个击发位置所产生的临床效果,对各组术后并发症发生情况进行描述分析。结果：PPH吻合器击发位置在齿状线以上1.5cm组与2.5cm组、3.0cm组的临床治疗效果,术后肛周疼痛及吻合口出血并发症比较有统计学意义（P〈0.05）;2.5cm组与3.0cm组的临床治疗效果比较无统计学差异（P〉0.05）。结论：PPH吻合器击发位置在齿状线以上2.5-3.0cm的临床治疗效果好,同时可减少术后肛周疼痛及出血等并发症。展开更多
文摘AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.
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Objective:To summarize the experience without hemorrhage after PPH of 218 patients with mixed hemorrhoid.Methods:PPH(Procedure for prolapse and hemorrhoids)was performed routinely.During operation,it is paid attention that the hemorrhoid artery should be completely mutilated,the anastomat should be squeezed before and after the anastomosis,the anastomosis should be carefully examined,the hemostasis should be completely performed,and relevant hemostasis measures should be taken after the operation.Results:None of the 218 patients had postoperative hemorrhage.Conclusion:Relevant measures can be taken after operation to prevent the occurrence of postoperative hemorrhage.
文摘目的探讨痔上黏膜环形切除订合术(procedure for prolapsed and hemorrhoids,PPH)加外痔切除术的临床疗效。方法治疗组48例采用PPH加外痔切除术,对照组48例采用外剥内扎术。结果治疗组手术时间、术后各合并症评分少于对照组,两组比较差异有统计学意义(P<0.05);治疗组手术疗效与对照组比较,差异无统计学意义(P>0.05);治疗组住院费用多于对照组,差异有统计学意义(P<0.05)。结论 PPH加外痔切除术临床疗效显著。
文摘目的:比较三种不同的吻合器痔上粘膜环形切除钉合术(procedure for prolapse andhaemorrhoids,PPH)手术的荷包缝合法及效果。方法:采用单荷包单圈缝合法(A组)、双荷包双圈缝合法(B组)以及双半荷包单圈缝合法(C组),对120例Ⅲ、Ⅳ度环状脱垂性内痔行PPH术,比较分析三组病例的手术时间、术中下腹部疼痛、切除直肠粘膜宽度、粘膜环完整性及均匀度、痔核回缩、吻合口部位、术中出血、痔核回缩度、术后肛门疼痛、术后出血及住院时间。结果:双半荷包单圈缝合后切除的直肠粘膜宽度cm、粘膜环完整性及均匀度、痔核回缩与双荷包双圈缝合法无显著性差异,优于单荷包单圈缝合法(P<0.05);双半荷包单圈缝合法及单荷包单圈缝合法手术时间较双荷包双圈缝合法时间缩短(P<0.05);术后肛门疼痛、术后出血及住院时间三组无显著性差异(P>0.05)。结论:双半荷包单圈缝合法能保证PPH手术切除直肠粘膜宽度、粘膜环完整性及均匀度、痔核回缩明显,且不增加手术程序及手术时间、具有一定的临床推广价值。
文摘目的:本研究通过对直肠内脱垂伴环状混合痔所致出口梗阻性便秘两种不同术式的近期、远期的临床疗效观察及直肠测压对两种不同术式术前和术后肛门功能客观评价,探索该类型便秘的更好治疗方法.方法:对2010-01/2012-12就诊并接受住院治疗的120例直肠内脱垂伴环状混合痔患者,采用随机区组分组方法分为两组,试验组[吻合器痔上黏膜环切术(procedure forprolapse and hemorrhoids,PPH)],对照组(传统术式,即混合痔外剥内扎+直肠黏膜套扎),两组术前术后分别进行直肠肛门压力检测,分析两组患者手术前后肛门功能指标的肛肠压力变化和便秘患者生活质量评价表(The Patient Assessment of Constipation Quality of Life,PAC-QOL).结果:直肠肛门测压研究中,两组手术后的直肠肛门检测出现不同程度的减弱.试验组患者的术前与术后各项直肠肛门测压指标差异无统计学意义(P>0.05),表明吻合器痔上黏膜环切术没有对患者的肛门功能造成影响,不改变正常肛门功能,对照组患者的术前与术后除直肠静息压外,各项肛门直肠测压指标差异有统计学意义(P<0.05).试验组和对照组术前术后差异比较,除直肠静息压外均有统计学意义(P<0.05),表明传统术式对正常的肛门功能造成了一定影响.两组患者手术后进行跟踪随访,通过应用生活质量量表的评价,PPH手术与传统手术相比各维度及总分的差异均有统计学意义,PPH术式组表现较好的生活质量.结论:采用PPH手术方式解决直肠内脱垂同时伴环状混合痔所致出口梗阻性便秘,跟传统术式(混合痔外剥内扎术+直肠黏膜套扎术)作比较,临床疗效优于后者,而且前者表现出较高的生活质量,值得临床上推广.
文摘目的：研究吻合器痔上粘膜环切术（procedure for prolapse and hemorrhoids,PPH）吻合器击发位置对内痔疗效及并发症的影响。方法：收集汕头大学医学院第一附属医院2004年至2009年的198例内痔患者,随机分成3组,并通过比较3组志愿者PPH吻合器分别在齿状线以上1.5cm、2.5cm、3.0cm三个击发位置所产生的临床效果,对各组术后并发症发生情况进行描述分析。结果：PPH吻合器击发位置在齿状线以上1.5cm组与2.5cm组、3.0cm组的临床治疗效果,术后肛周疼痛及吻合口出血并发症比较有统计学意义（P〈0.05）;2.5cm组与3.0cm组的临床治疗效果比较无统计学差异（P〉0.05）。结论：PPH吻合器击发位置在齿状线以上2.5-3.0cm的临床治疗效果好,同时可减少术后肛周疼痛及出血等并发症。
