Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Hui ¹ , XU Su ¹ , YANG Xiaoling ¹ ,  CHEN Hongjin ² , GU Yunfei ² , YANG Bolin ²

1. The Hospital Affiliated to Nanjing University of Chinese Traditional Medicine, Nanjing, Jiangsu 210029, P.R.China;
2. Department of Anorectal, The First Affiliated Hospital of Nanjing University of Chinese Traditional Medicine/Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R.China;

Corresponding author：

CHEN Hongjin, Email: chjltp@163.com

Keywords：

pouched suture; external dissection and internal ligation; mixed hemorrhoids

DOI：

10.7507/1007-9424.201609071

Video：

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Objective To investigate the clinical efficacy of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids. Methods Seventy patients with Ⅲ-Ⅳ internal henmorrhoids and mixed hemorrhoids who were admitted into Jiangsu Provincial Hospital of Traditional Chinese Medicine form June 2015 to June 2016 were enrolled. The patients were randomly divided into two groups: the combined operativ group and control group. The combined operativ group in which 35 cases were treated by pouched suture plus external dissection and internal ligation, and the control group in which 35 cases were treated by external dissection and internal ligation. The wound healing time, clinical curative effect, hospital stay, the operative time and postoperative complications (postoperative pain, edema, postoperative bleeding volume, urination difficulties, residual skin tag, anorectal stenosis) between two groups were compared. Results No significant difference were found in the clinical curative effect, the operative time and anorectal stenosis in two groups (P>0.05).　The visual analogue scale (VAS) scores and the edema scores of the combined operativ group on the first day, the third day, and the fifth day after operation were lower than those of control group, the difference was statistically significant (P<0.05), while there were no statistically significant on the seventh day after operation in two groups (P>0.05) . The wound healing time, hospital stay, postoperative bleeding volume, urination difficulties, and residual skin tag in the combined operativ group were significantly shorter or lower than those in the control group (P<0.05). Conclusion Pouched suture plus external dissection and internal ligation has the advantages of less pain, fewer complications and quicker recovery, it also meets the modern concept of minimally invasive, so it is worthy of popularization and application.

Citation： WANG Hui, XU Su, YANG Xiaoling, CHEN Hongjin, GU Yunfei, YANG Bolin. Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 453-457. doi: 10.7507/1007-9424.201609071 Copy

1.	任东林, 胡邦. 重视肛门直肠良性疾病的诊治. 中华胃肠外科杂志, 2014, 17(12): 1161-1163.
2.	田振国, 陈平. 中国成人常见肛肠疾病流行病学调查. 武汉: 武汉大学出版社, 2015: 33-61.
3.	Imbelloni LE, Vieria EM, Carneiro AF. Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: A controlled clinical study. J Coloproctol, 2012, 32(3): 291-296.
4.	Marino AW Jr. Symposium: anorectal surgery—hemorrhoids. Dis Colon Rectum, 1980, 23(4): 211-222.
5.	Milligan ETC, Morgan CN, Jones LE,et al. Surgical anatomy of the anal canal, and the operative treatment of hemorrhoids. Lancet, 1937, 2(11): 1119-1124.
6.	Towliat Kashani SM, Mehrvarz S, Mousavi Naeini SM,et al. Milligan-Morgan hemorrhoidectomy vs stapled hemorrhoidopexy. Trauma Mon, 2012, 16(4): 175-177.
7.	丁义江, 皇甫少华. 痔诊断和治疗指南 (2010 修订版). 中华消化外科杂志, 2012, 11(3): 243-247.
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10.	杨纪红, 牟洁霏, 何洪波. 肛门内括约肌部分切开术在混合痔外剥内扎术中的应用. 华西医学, 2014, 29(3): 508-510.
11.	王秀珍, 郭琳, 张宏玺. TST 与外剥内扎术治疗混合痔的临床疗效观察. 结直肠肛门外科, 2015, 21(2): 109-111.
12.	应欣, 曾莉, 钱海华. 痔手术研究进展. 现代中西医结合杂志, 2012, 21(31): 3529-3532.
13.	邹占云, 王爱华. 吻合器痔切闭术与传统痔切闭术的临床疗效比较. 湖南中医学院学报, 2005, 25(6): 48-49.
14.	Panarese A, Pironi D, Vendettuoli M,et al. Stapled and conventional Milligan-Morgan hemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis, 2012, 27(4): 483-487.
15.	Sammarco G, Ferrari F, Carpino A,et al. PPHvs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse. Ann Ital Chir, 2013, 23(7): 84-87.
16.	唐茂山. 自动痔疮套扎术与外剥内扎术治疗Ⅲ、Ⅳ期混合痔的对照研究. 中华全科医学, 2016, 14(3): 397-399.
17.	王静, 黄峰. 外剥内扎注射加内括约肌松解术治疗环状混合痔临床观察. 中国中医急症, 2015, 24(8): 1446-1447.
18.	邓志灏, 赵宝明. 痔外剥内扎术后的解痉治疗. 世界华人消化杂志, 2013, 21(19): 1828-1833.
19.	李宇飞, 何孝康, 王晓锋, 等. 痔术后肛缘水肿的防治策略.结直肠肛门外科, 2014, 20(1): 72-75.
20.	倪海叶, 任清文. 两种手术方法治疗混合痔的疗效比较. 中国普外基础与临床杂志, 2010, 17(8): 847-848.
21.	Amoli HA, Notash AY, Shahandashti FJ,et al. A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Colorectal Dis, 2011, 13(3): 328-332.

1. 任东林, 胡邦. 重视肛门直肠良性疾病的诊治. 中华胃肠外科杂志, 2014, 17(12): 1161-1163.
2. 田振国, 陈平. 中国成人常见肛肠疾病流行病学调查. 武汉: 武汉大学出版社, 2015: 33-61.
3. Imbelloni LE, Vieria EM, Carneiro AF. Postoperative analgesia for hemorrhoidectomy with bilateral pudendal blockade on an ambulatory patient: A controlled clinical study. J Coloproctol, 2012, 32(3): 291-296.
4. Marino AW Jr. Symposium: anorectal surgery—hemorrhoids. Dis Colon Rectum, 1980, 23(4): 211-222.
5. Milligan ETC, Morgan CN, Jones LE,et al. Surgical anatomy of the anal canal, and the operative treatment of hemorrhoids. Lancet, 1937, 2(11): 1119-1124.
6. Towliat Kashani SM, Mehrvarz S, Mousavi Naeini SM,et al. Milligan-Morgan hemorrhoidectomy vs stapled hemorrhoidopexy. Trauma Mon, 2012, 16(4): 175-177.
7. 丁义江, 皇甫少华. 痔诊断和治疗指南 (2010 修订版). 中华消化外科杂志, 2012, 11(3): 243-247.
8. 国家中医药管理局. 中华人民共和国中医药行业标准•中医病证诊断疗效标准 (2012 版).北京: 中国医药科技出版社, 2012: 53-54.
9. Woodforde JM, Merskey H. Some relationships between subjective measures of pain. J Psychosom Res, 1972, 16(3): 173-178.
10. 杨纪红, 牟洁霏, 何洪波. 肛门内括约肌部分切开术在混合痔外剥内扎术中的应用. 华西医学, 2014, 29(3): 508-510.
11. 王秀珍, 郭琳, 张宏玺. TST 与外剥内扎术治疗混合痔的临床疗效观察. 结直肠肛门外科, 2015, 21(2): 109-111.
12. 应欣, 曾莉, 钱海华. 痔手术研究进展. 现代中西医结合杂志, 2012, 21(31): 3529-3532.
13. 邹占云, 王爱华. 吻合器痔切闭术与传统痔切闭术的临床疗效比较. 湖南中医学院学报, 2005, 25(6): 48-49.
14. Panarese A, Pironi D, Vendettuoli M,et al. Stapled and conventional Milligan-Morgan hemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis, 2012, 27(4): 483-487.
15. Sammarco G, Ferrari F, Carpino A,et al. PPHvs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse. Ann Ital Chir, 2013, 23(7): 84-87.
16. 唐茂山. 自动痔疮套扎术与外剥内扎术治疗Ⅲ、Ⅳ期混合痔的对照研究. 中华全科医学, 2016, 14(3): 397-399.
17. 王静, 黄峰. 外剥内扎注射加内括约肌松解术治疗环状混合痔临床观察. 中国中医急症, 2015, 24(8): 1446-1447.
18. 邓志灏, 赵宝明. 痔外剥内扎术后的解痉治疗. 世界华人消化杂志, 2013, 21(19): 1828-1833.
19. 李宇飞, 何孝康, 王晓锋, 等. 痔术后肛缘水肿的防治策略.结直肠肛门外科, 2014, 20(1): 72-75.
20. 倪海叶, 任清文. 两种手术方法治疗混合痔的疗效比较. 中国普外基础与临床杂志, 2010, 17(8): 847-848.
21. Amoli HA, Notash AY, Shahandashti FJ,et al. A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Colorectal Dis, 2011, 13(3): 328-332.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on application of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids

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