Objective To observe the therapeutic efficacy of ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation for the treatment of four degree mixed hemorrhoids. Methods The patients with four degree mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2023 to June 2023 were included as the study subjects, then were randomly averagely divided into an observation group (underwent ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation) and a control group (underwent Milligan-Morgan hemorrhoidectomy) by a random number table method. The therapeutic efficacy, total hospitalization time, operation time, intraoperative blood loss, wound healing time, hospitalization costs, postoperative pain score, bleeding score, wound edema score, postoperative complications (anal stenosis, urinary retention, anal incontinence), and recurrence were compared between the two groups. Results A total of 100 patients with four degree mixed hemorrhoids treated in this hospital were included, with 50 patients in each group. There were no statistically significant differences in the general information such as the gender, age, disease course, body mass index, hematochezia, and tumor prolapse between the two groups (P>0.05). ① The overall therapeutic efficacy both the observation group and the control group was well (100% versus 96.0%, Fisher exact test, P=0.495). ② The observation group had less total hospitalization time, operation time, intraoperative blood loss, hospitalization costs, and wound healing time as compared with the control group (P<0.05). ③ The differences in the interaction effects of the time-group for the points of postoperative pain, bleeding, and wound edema were not statistically significant (χ²=6.668, P=0.083; χ²=5.500, P=0.139; χ²=6.204, P=0.102). However, the main effects of group (χ²=5.073, P=0.024; χ²=7.107, P=0.008; χ²=8.857, P=0.003) and time (χ²=188.526, P<0.001; χ²=212.472, P<0.001; χ²=185.110, P<0.001) showed statistically significant differences. The points of postoperative pain, bleeding, and wound edema in the observation group were statistically lower than thoes in the control group (χ²=9.323, P=0.002; χ²=18.133, P<0.001; χ²=6.232, P=0.013). ④ The incidences of postoperative urinary retention and anal stenosis in the observation group were lower than those in the control group (P=0.046 and 0.031, respectively), there were no statistically significant differences in the incidences of incontinence and postoperative recurrence between the two groups (P>0.05). Conclusion From the preliminary research results of this study, ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation has a better efficacy in treating four degree mixed hemorrhoids, with a smaller wound, faster healing, higher safety, and fewer complications.

Citation： JIANG Yaxin, YANG Huiju, LIU Xiang, CUI Shichao, LIU Dianwen. Treatment of four degree mixed hemorrhoids by ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation and Milligan-Morgan hemorrhoidectomy: a randomized controlled study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(7): 833-839. doi: 10.7507/1007-9424.202401076 Copy