Comparative Study of Anorectal Pressure after Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Hemorrhoidectomy in The Treatment of Mixed Hemorrhoid of Ⅲ-Degree_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUYang ,  LUMing

Department of Anorectal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

LUMing, Email: luming123luming@163.com

Keywords：

Mixed hemorrhoids of Ⅲ-degree; Procedure for prolapse and hemorrhoids; Milligan-Morgan hemorr- hoidectomy; Anorectal pressure; Prospective study

DOI：

10.7507/1007-9424.20160183

Video：

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Objective To compare the postoperative anorectal pressure after procedure for prolapse and hemorrhoids (PPH) and Milligan-Morgan hemorrhoidectomy (MMH) in treatment of patients with mixed hemorrhoid of Ⅲ-degree. Methods In total of 112 patients with mixed hemorrhoid of Ⅲ-degree who underwent PPH (n=60) or MMH (n=52) in The First Affiliated Hospital of Xinjiang Medical University between March 2014 to March 2015 were prospectively enrolled, the type of surgery was according to patients’ individual choice. In 6 months after operation, all patients under-went the examination of anorectal manometry which including rectal anal inhibitory reflex, rectal resting pressure, anal resting pressure, maximal anal contractive pressure, and anal canal length of high pressure belt. Results In 6 months after operation, the positive rate of rectal anal inhibitory reflex 〔88.3% (53/60) vs. 61.5% (32/52)〕 , anal resting pressure 〔(56.42± 2.25) mm Hg vs. (46.31±2.58) mm Hg〕, and anal canal length of high pressure belt 〔(3.35±0.12) cm vs. (2.29±0.23) cm〕 of PPH group were all significantly higher than those of MMH group (P＜0.05), but there was no statistical significance between PPH group and MMH group in rectal resting pressure 〔(5.51±1.26) mm Hg vs. (5.39±1.85) mm Hg〕 and maximal anal contractive pressure 〔(156.64±9.78) mm Hg vs. (155.32±8.53) mm Hg〕, P>0.05. Conclusion PPH and MMH are all effective to treat mixed hemorrhoids of Ⅲ-degree, but PPH is more positive in protection of anal function.

Citation： LIUYang, LUMing. Comparative Study of Anorectal Pressure after Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Hemorrhoidectomy in The Treatment of Mixed Hemorrhoid of Ⅲ-Degree. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 687-690. doi: 10.7507/1007-9424.20160183 Copy

1.	朱军, 丁健华, 赵克, 等. 吻合器痔上黏膜环切钉合术与开放式外剥内扎痔切除术治疗Ⅲ度痔远期疗效比较. 中国实用外科杂志, 2012, 32(5): 398-402.
2.	Laughlan K, Jayne DG, Jackson D, et al. Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review. Int J Colorectal Dis, 2009, 24(3): 335-344.
3.	刘洪喜, 任远. 吻合器痔上黏膜环切术联合外痔切除术治疗重度混合痔的疗效分析. 中国临床医学, 2014, 21(6): 665-667.
4.	Lu M, Shi GY, Wang GQ, et al. Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids. World J Gastroenterol, 2013, 19(30): 5011-5015.
5.	刘扬, 刘青, 杨润清, 等. PPH联合外剥内扎术及皮桥整形术治疗重度环状混合痔的临床疗效观察. 中国普通外科杂志, 2015, 24(2): 297-299.
6.	王国强, 刘扬, 刘青, 等. 吻合器痔上黏膜环切术的近远期疗效及安全性的Meta分析. 中华外科杂志, 2013, 51(11): 1034-1038.
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.	Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device：a new procedure. 6th ed. Rome: World Congress of Endoscopic Surgery, 1998: 777-784.
9.	Milligan ETC, Morgan CN. Surgical anatomy of the anal canal and operative treatment of hemorrhoids. Lancet, 1937, 2(3): 1119-1124.
10.	董晓妮, 唐迎春. 吻合器痔上黏膜环切钉合术与超声引导下痔动脉结扎术治疗Ⅲ度混合痔术后肛管直肠压力的比较研究. 中华胃肠外科杂志, 2013, 16(12): 1183-1186.
11.	王智凤, 柯美云, 孙晓红, 等. 功能性便秘患者肛门直肠动力学和感觉功能测定及其临床意义. 中华消化杂志, 2004, 24(9): 526-529.
12.	Kuiken SD, Lindeboom R, Tytgat GN, et al. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther, 2005, 22(2): 157-164.
13.	费贤彬, 彭俊杰, 吴坚, 等. 吻合器痔上黏膜环切术治疗重度痔病128例临床观察. 中国普外基础与临床杂志, 2012, 19(4): 440-442.
14.	Perez F, Arroyo A, Serrano P, et al. Prospective clinical and mano-metric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano. Int J Colorectal Dis, 2006, 21(6): 522-526.
15.	林细州, 陈艳, 陆小锋, 等. 高分辨率肛门直肠测压与生物反馈治疗在出口梗阻型便秘患者中的应用. 实用医学杂志, 2015, 31(17): 2851-2854.
16.	Rao SS, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome Ⅱ criteria in dyssynergic defe-cation (Anismus). Neurogastroenterol Motil, 2004, 16(5): 589-596.
17.	Kouraklis G, Andromanakos N. Anorectal incontinence: aetiology, pathophysiology and evaluation. Acta Chir Belg, 2004, 104(1): 81-91.
18.	路明. 直肠内脱垂伴环状混合痔所致便秘临床治疗对比研究. 新疆: 新疆医科大学, 2014: 33-37.
19.	Wałega P, Scheyer M, Kenig J, et al. Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrho-idal artery ligation: functional results after 1-year follow-up. Surg Endosc, 2008, 22(11): 2379-2383.
20.	Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy—costand effectiveness. Randomized, controlled trial including incontin-ence scoring, anorectal manometry, and endoanal ultrasound assess-ments at up to three months. Dis Colon Rectum, 2000, 43(12): 1666-1675.
21.	Tjandra JJ, Chan MK. Systematic review on the procedure for prol-apse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum, 2007, 50(6): 878-892.

1. 朱军, 丁健华, 赵克, 等. 吻合器痔上黏膜环切钉合术与开放式外剥内扎痔切除术治疗Ⅲ度痔远期疗效比较. 中国实用外科杂志, 2012, 32(5): 398-402.
2. Laughlan K, Jayne DG, Jackson D, et al. Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review. Int J Colorectal Dis, 2009, 24(3): 335-344.
3. 刘洪喜, 任远. 吻合器痔上黏膜环切术联合外痔切除术治疗重度混合痔的疗效分析. 中国临床医学, 2014, 21(6): 665-667.
4. Lu M, Shi GY, Wang GQ, et al. Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids. World J Gastroenterol, 2013, 19(30): 5011-5015.
5. 刘扬, 刘青, 杨润清, 等. PPH联合外剥内扎术及皮桥整形术治疗重度环状混合痔的临床疗效观察. 中国普通外科杂志, 2015, 24(2): 297-299.
6. 王国强, 刘扬, 刘青, 等. 吻合器痔上黏膜环切术的近远期疗效及安全性的Meta分析. 中华外科杂志, 2013, 51(11): 1034-1038.
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. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device：a new procedure. 6th ed. Rome: World Congress of Endoscopic Surgery, 1998: 777-784.
9. Milligan ETC, Morgan CN. Surgical anatomy of the anal canal and operative treatment of hemorrhoids. Lancet, 1937, 2(3): 1119-1124.
10. 董晓妮, 唐迎春. 吻合器痔上黏膜环切钉合术与超声引导下痔动脉结扎术治疗Ⅲ度混合痔术后肛管直肠压力的比较研究. 中华胃肠外科杂志, 2013, 16(12): 1183-1186.
11. 王智凤, 柯美云, 孙晓红, 等. 功能性便秘患者肛门直肠动力学和感觉功能测定及其临床意义. 中华消化杂志, 2004, 24(9): 526-529.
12. Kuiken SD, Lindeboom R, Tytgat GN, et al. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther, 2005, 22(2): 157-164.
13. 费贤彬, 彭俊杰, 吴坚, 等. 吻合器痔上黏膜环切术治疗重度痔病128例临床观察. 中国普外基础与临床杂志, 2012, 19(4): 440-442.
14. Perez F, Arroyo A, Serrano P, et al. Prospective clinical and mano-metric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano. Int J Colorectal Dis, 2006, 21(6): 522-526.
15. 林细州, 陈艳, 陆小锋, 等. 高分辨率肛门直肠测压与生物反馈治疗在出口梗阻型便秘患者中的应用. 实用医学杂志, 2015, 31(17): 2851-2854.
16. Rao SS, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome Ⅱ criteria in dyssynergic defe-cation (Anismus). Neurogastroenterol Motil, 2004, 16(5): 589-596.
17. Kouraklis G, Andromanakos N. Anorectal incontinence: aetiology, pathophysiology and evaluation. Acta Chir Belg, 2004, 104(1): 81-91.
18. 路明. 直肠内脱垂伴环状混合痔所致便秘临床治疗对比研究. 新疆: 新疆医科大学, 2014: 33-37.
19. Wałega P, Scheyer M, Kenig J, et al. Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrho-idal artery ligation: functional results after 1-year follow-up. Surg Endosc, 2008, 22(11): 2379-2383.
20. Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy—costand effectiveness. Randomized, controlled trial including incontin-ence scoring, anorectal manometry, and endoanal ultrasound assess-ments at up to three months. Dis Colon Rectum, 2000, 43(12): 1666-1675.
21. Tjandra JJ, Chan MK. Systematic review on the procedure for prol-apse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum, 2007, 50(6): 878-892.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study of Anorectal Pressure after Procedure for Prolapse and Hemorrhoids Versus Milligan-Morgan Hemorrhoidectomy in The Treatment of Mixed Hemorrhoid of Ⅲ-Degree

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