Analysis of the effect and postoperative recurrence of grade <b>Ⅳ</b> mixed hemorrhoids treated by C<b>-</b>shaped mucosal resection and anastomosis above the dentate line_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Tiegang ¹ ,  DUAN Chuanyou ¹ , WU Guokui ² , HAN Jianbo ² , TONG Fei ² , ZHANG Bo ³ , CAO Hongyong ⁴

1. Department of General Surgery, Nanjing Liuhe District People’s Hospital (Liuhe Hospital Affiliated to Yangzhou University Medical College), Nanjing 210000, P. R. China;
2. Department of General Surgery, Nanjing Red Cross Hospital, Nanjing 210001, P. R. China;
3. Department of Proctology, Zhongda Hospital Southeast University, Nanjing 210009, P. R. China;
4. Department of General Surgery, Nanjing Hospital of Nanjing Medical University (Nanjing First Hospital), Nanjing 210006, P. R. China;

Corresponding author：

DUAN Chuanyou, Email: yangza98445@163.com

Keywords：

degree Ⅳ mixed hemorrhoids; C-shaped mucosal resection and anastomosis above the dentate line; curative effect; anal function

DOI：

10.7507/1007-9424.202307032

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the curative effect of C-shaped mucosal resection and anastomosis above the dentate line in the treatment of mixed hemorrhoids and its effect on anal function. Methods A total of 78 patients with degree Ⅳ mixed hemorrhoids treated in Nanjing Liuhe District People’s Hospital from June 2015 to February 2018 were retrospectively collected. The patients were divided into control group (n=39) and observation group (n=39) according to treatment methods. Patients of the control group received traditional procedure for prolapse and hemorrhoids operation, while patients of the observation group received C-shaped mucosal resection and anastomosis above the dentate line. The perioperative indexes (operation time, intraoperative blood loss, hospital stay, etc.), subjective function evaluation indexes (Wexner constipation score, Kirwan grade, etc.), clinical efficacy and recurrence rate were compared between the two groups. The random walking model was used to evaluate the clinical curative effect. Results The intraoperative blood loss [(27.9±3.4) mL vs. (43.2±5.2) mL, P<0.001], 24 h visual analogue scale score [(4.2±1.5) points vs. (5.6±1.5) points, P<0.001], duration of first defecation pain [(22.1±3.2) min vs. (34.2±5.0) min, P<0.001], the time of carrying blood [(4.1±0.4) d vs. (5.7±0.6) d, P<0.001], and the time of edema [(3.2±0.6) d vs. (4.7±0.9) d, P<0.001] in the observation group were shorter (lower) than those in the control group. The difference between pre-and post-operation of Wexner constipation score [(13.2±2.4) points vs. (11.7±2.1) points, P=0.004], resting pressure [(23.1±4.9) mmHg vs. (17.8±3.4) mmHg, P<0.001] and maximum squeeze pressure [(33.5±7.3) mmHg vs. (23.1±5.6) mmHg, P<0.001] in the observation group were significantly higher than those in the control group. There was a long-term correlation between changes in random fluctuating power rate values of Wexner constipation score, Kirwan grade, rectoanal inhibitory reflex positive rate, resting pressure, maximum squeeze pressure and the surgical procedure received by the patient of the two groups. The total effective rate [97.4% (38/39) vs. 66.7% (26/39)] and non-recurrence rate [92.3% (36/39) vs. 76.9% (29/39)] in the observation group were higher than those in the control group, while there was no significant difference in the incidence of total complications between the two groups [5.1% (2/39) vs. 12.8% (5/39), P=0.235)]. Conclusion Compared with PPH, C-shaped mucosal resection and anastomosis above the dentate line for the treatment of degree Ⅳ mixed hemorrhoids can improve the therapeutic effect, reduce postoperative recurrence, maintain anal function and facilitate the recovery of patients.

Citation： WANG Tiegang, DUAN Chuanyou, WU Guokui, HAN Jianbo, TONG Fei, ZHANG Bo, CAO Hongyong. Analysis of the effect and postoperative recurrence of grade Ⅳ mixed hemorrhoids treated by C-shaped mucosal resection and anastomosis above the dentate line. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 726-732. doi: 10.7507/1007-9424.202307032 Copy

1.	Perivoliotis K, Spyridakis M, Zintzaras E, et al. Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial. Int J Colorectal Dis, 2021, 36(2): 353-363.
2.	Giamundo P, De Angelis M, Mereu A. Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol, 2020, 24(2): 199-205.
3.	Acar T, Acar N, Tosun F, et al. House advancement flap anoplasty for severe post-hemorrhoidectomy anal stenosis. Tech Coloproctol, 2020, 24(3): 261-262.
4.	魏欣, 黄丹, 胡发涌, 等. PPH结合内痔缝扎术治疗重度内痔的临床疗效. 腹部外科, 2020, 33(2): 156-158.
5.	谭玉成, 陆航. 吻合器经肛门直肠黏膜选择性切除钉合术治疗低位直肠良性肿瘤临床疗效研究. 陕西医学杂志, 2021, 50(5): 572-574, 578.
6.	徐林生, 胡炳德, 梁丁保, 等. 内镜下负压套扎术和痔上黏膜环切术治疗Ⅱ/Ⅲ度内痔的疗效对比. 现代消化及介入诊疗, 2020, 25(4): 527-528, 532.
7.	中华医学会外科学分会结直肠肛门外科学组, 中华中医药学会肛肠病专业委员会, 中国中西医结合学会结直肠肛门病专业委员会. 痔临床诊治指南 (2006版). 中华胃肠外科杂志, 2006, 9(5): 461-463.
8.	Luedi MM, Schober P, Hammoud B, et al. Preoperative pressure pain threshold is associated with postoperative pain in short-stay anorectal surgery: a prospective observational study. Anesth Analg, 2021, 132(3): 656-662.
9.	Jangö H, Langhoff-Roos J, Rosthøj S, et al. Wexner score and quality of life in women with obstetric anal sphincter injury. Int Urogynecol J, 2020, 31(6): 1115-1121.
10.	Tuan NA, Duc NM, Van Hiep P, et al. The efficacy of transanal total mesorectal excision: a preliminary vietnamese report. Med Arch, 2020, 74(3): 216-223.
11.	Liang Y, An T, Xin W. Exploring the value of rectal anal canal pressure measurement in the diagnosis of Hirschsprung’s disease. Heliyon, 2022, 8(6): e09619.
12.	赵学尧, 刘孟宇, 韩学杰, 等. 《中医肛肠科常见病诊疗指南》临床应用评价研究. 中国中药杂志, 2017, 42(17): 3252-3256.
13.	Eberspacher C, Mascagni P, Di Nardo D, et al. Caiman versus LigaSure hemorrhoidectomy: postoperative pain, early complications, long-term follow-up, and costs. Surg Innov, 2020, 27(3): 272-278.
14.	Wang X, Yin X, Guo XT, et al. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: a randomized controlled trial. J Integr Med, 2020, 18(6): 492-498.
15.	Rho M, Guida AM, Materazzo M, et al. Ligasure hemorrhoidectomy: updates on complications after an 18-year experience. Rev Recent Clin Trials, 2021, 16(1): 101-108.
16.	Yu K, Li H, Xue P, et al. Modified ultrasound scalpel haemorr-hoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial. Trials, 2023, 24(1): e140. doi: 10.1186/s13063-023-07175-6.
17.	Du B, Xu Z, Zhong X. Electroacupuncture for postoperative pain in mixed hemorrhoids: a meta-analysis. Medicine (Baltimore), 2022, 101(50): e32247. doi: 10.1097/MD.0000000000032247.
18.	梁凤, 乔晓, 韩成艳, 等. 内镜下橡皮圈套扎术与经典外科手术吻合器痔上黏膜环切钉合术治疗痔疮的临床疗效. 中国内镜杂志, 2023, 29(2): 13-19.
19.	Huang H, Wen K, Ding X, et al. The efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation in circumferential mixed hemorrhoids: a randomized controlled trial. Langenbecks Arch Surg, 2023, 408(1): e332. doi: 10.1007/s00423-023-03081-2.
20.	Pei X, Song S, Li H, et al. Efficacy and safety of acupoint catgut embedding in treating postoperative pain of mixed hemorrhoids: a randomized controlled trial protocol. Medicine (Baltimore), 2021, 100(19): e25948. doi: 10.1097/MD.0000000000025948.
21.	Feng J, Cheng J, Xiang F. Management of intractable pain in patients treated with hemorrhoidectomy for mixed hemorrhoids. Ann Palliat Med, 2021, 10(1): 479-483.
22.	吕兵兵, 魏东, 张远耀, 等. 腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术治疗完全性直肠脱垂的疗效分析. 中华普通外科杂志, 2020, 35(9): 713-715.
23.	范雷涛, 孙源, 李春雨. 比较两种联合术式治疗混合痔的临床疗效和肛肠动力学变化. 中国普外基础与临床杂志, 2021, 28(1): 79-84.
24.	Shen J, Zhou X, Zhao J, et al. Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial. Int J Colorectal Dis, 2023, 38(1): e104. doi: 10.1007/s00384-023-04403-y.
25.	张慧嫦, 熊秋华, 罗秀琼. PPH联合部分肛门内括约肌切断术应用于重度混合痔并直肠肛管静息压高压患者的疗效观察. 中国普外基础与临床杂志, 2020, 27(4): 454-459.

1. Perivoliotis K, Spyridakis M, Zintzaras E, et al. Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial. Int J Colorectal Dis, 2021, 36(2): 353-363.
2. Giamundo P, De Angelis M, Mereu A. Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol, 2020, 24(2): 199-205.
3. Acar T, Acar N, Tosun F, et al. House advancement flap anoplasty for severe post-hemorrhoidectomy anal stenosis. Tech Coloproctol, 2020, 24(3): 261-262.
4. 魏欣, 黄丹, 胡发涌, 等. PPH结合内痔缝扎术治疗重度内痔的临床疗效. 腹部外科, 2020, 33(2): 156-158.
5. 谭玉成, 陆航. 吻合器经肛门直肠黏膜选择性切除钉合术治疗低位直肠良性肿瘤临床疗效研究. 陕西医学杂志, 2021, 50(5): 572-574, 578.
6. 徐林生, 胡炳德, 梁丁保, 等. 内镜下负压套扎术和痔上黏膜环切术治疗Ⅱ/Ⅲ度内痔的疗效对比. 现代消化及介入诊疗, 2020, 25(4): 527-528, 532.
7. 中华医学会外科学分会结直肠肛门外科学组, 中华中医药学会肛肠病专业委员会, 中国中西医结合学会结直肠肛门病专业委员会. 痔临床诊治指南 (2006版). 中华胃肠外科杂志, 2006, 9(5): 461-463.
8. Luedi MM, Schober P, Hammoud B, et al. Preoperative pressure pain threshold is associated with postoperative pain in short-stay anorectal surgery: a prospective observational study. Anesth Analg, 2021, 132(3): 656-662.
9. Jangö H, Langhoff-Roos J, Rosthøj S, et al. Wexner score and quality of life in women with obstetric anal sphincter injury. Int Urogynecol J, 2020, 31(6): 1115-1121.
10. Tuan NA, Duc NM, Van Hiep P, et al. The efficacy of transanal total mesorectal excision: a preliminary vietnamese report. Med Arch, 2020, 74(3): 216-223.
11. Liang Y, An T, Xin W. Exploring the value of rectal anal canal pressure measurement in the diagnosis of Hirschsprung’s disease. Heliyon, 2022, 8(6): e09619.
12. 赵学尧, 刘孟宇, 韩学杰, 等. 《中医肛肠科常见病诊疗指南》临床应用评价研究. 中国中药杂志, 2017, 42(17): 3252-3256.
13. Eberspacher C, Mascagni P, Di Nardo D, et al. Caiman versus LigaSure hemorrhoidectomy: postoperative pain, early complications, long-term follow-up, and costs. Surg Innov, 2020, 27(3): 272-278.
14. Wang X, Yin X, Guo XT, et al. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: a randomized controlled trial. J Integr Med, 2020, 18(6): 492-498.
15. Rho M, Guida AM, Materazzo M, et al. Ligasure hemorrhoidectomy: updates on complications after an 18-year experience. Rev Recent Clin Trials, 2021, 16(1): 101-108.
16. Yu K, Li H, Xue P, et al. Modified ultrasound scalpel haemorr-hoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial. Trials, 2023, 24(1): e140. doi: 10.1186/s13063-023-07175-6.
17. Du B, Xu Z, Zhong X. Electroacupuncture for postoperative pain in mixed hemorrhoids: a meta-analysis. Medicine (Baltimore), 2022, 101(50): e32247. doi: 10.1097/MD.0000000000032247.
18. 梁凤, 乔晓, 韩成艳, 等. 内镜下橡皮圈套扎术与经典外科手术吻合器痔上黏膜环切钉合术治疗痔疮的临床疗效. 中国内镜杂志, 2023, 29(2): 13-19.
19. Huang H, Wen K, Ding X, et al. The efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation in circumferential mixed hemorrhoids: a randomized controlled trial. Langenbecks Arch Surg, 2023, 408(1): e332. doi: 10.1007/s00423-023-03081-2.
20. Pei X, Song S, Li H, et al. Efficacy and safety of acupoint catgut embedding in treating postoperative pain of mixed hemorrhoids: a randomized controlled trial protocol. Medicine (Baltimore), 2021, 100(19): e25948. doi: 10.1097/MD.0000000000025948.
21. Feng J, Cheng J, Xiang F. Management of intractable pain in patients treated with hemorrhoidectomy for mixed hemorrhoids. Ann Palliat Med, 2021, 10(1): 479-483.
22. 吕兵兵, 魏东, 张远耀, 等. 腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术治疗完全性直肠脱垂的疗效分析. 中华普通外科杂志, 2020, 35(9): 713-715.
23. 范雷涛, 孙源, 李春雨. 比较两种联合术式治疗混合痔的临床疗效和肛肠动力学变化. 中国普外基础与临床杂志, 2021, 28(1): 79-84.
24. Shen J, Zhou X, Zhao J, et al. Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial. Int J Colorectal Dis, 2023, 38(1): e104. doi: 10.1007/s00384-023-04403-y.
25. 张慧嫦, 熊秋华, 罗秀琼. PPH联合部分肛门内括约肌切断术应用于重度混合痔并直肠肛管静息压高压患者的疗效观察. 中国普外基础与临床杂志, 2020, 27(4): 454-459.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the effect and postoperative recurrence of grade Ⅳ mixed hemorrhoids treated by C-shaped mucosal resection and anastomosis above the dentate line

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content