目的 探讨吻合器痔上黏膜环切术(ＰＰＨ)对巨大型Ⅲ、Ⅳ度环状痔的临床应用价值。方法 采用美国强生公司生产的痔疮吻合器对38例巨大型Ⅲ、Ⅳ度环状痔患者进行手术,并分析其临床资料。结果 患者平均手术时间19 min,术后平均住院2.8 d，术后10例肛门疼痛较剧者使用了镇痛剂（其中6例加切了外痔）,13例有轻度疼痛，15例无疼痛。术后9例1～6 d有便血,其中1例为大出血，出血量约1 000 ml，均经保守治疗后好转。随访1～19个月，患者无大便失禁、肛周感染、脓肿及肛门狭窄发生。结论 ＰＰＨ治疗巨大型Ⅲ、Ⅳ度环状痔具有手术时间短、住院时间少、痛苦小、恢复快、疗效显著、并发症少的优势。
目的 观察帕瑞昔布钠超前镇痛在痔上黏膜环切术中对丙泊酚半数有效效应室靶浓度和对术后视觉模拟评分法（VAS） 的影响。 方法 2010年3月－2011年10月择期手术患者60例，随机分为帕瑞昔布组（试验组）和生理盐水组（对照组），每组各30例，分别于术前10 min静脉注射帕瑞昔布钠40 mg或生理盐水2 mL。痔上黏膜环切时靶控输注丙泊酚，其靶控浓度按序贯法确定，相邻靶浓度之间对数差为0.05。观察两组丙泊酚的有效浓度及术后2、4、8、24 h的VAS评分。 结果 试验组的半数有效效应室靶控浓度（4.30 μg/mL）低于对照组（4.95 μg/mL），差异有统计学意义（P＜0.05）。术后4、8、24 h试验组VAS评分明显低于对照组，差异有统计学意义（P＜0.05）。 结论 帕瑞昔布钠可以减少术中丙泊酚的用量，并可得到满意的术后镇痛效果。
目的 探讨吻合器痔上黏膜环切术（PPH）的操作技巧、临床疗效及并发症。方法 根据患者具体情况，采用PPH术个性化治疗重度痔病患者128例，分析其手术操作技巧与临床疗效及术中、术后并发症的关系。结果 手术持续时间平均为30min，切除组织宽度平均为3.5cm。术中出血58例，其中渗血42例，搏动性出血16例。术后出血5例，吻合口感染1例；无大便失禁、吻合口狭窄。术后6个月随访，106例外脱痔块完全回缩，7例回缩不全，15例失访。结论 PPH术已被初步证明是一种微创、安全、有效的手术，但尚需进一步的经验积累及大规模临床试验加以验证。
ObjectiveTo evaluate the safety of shearing fracture ligation combining procedure for prolapse and hemorrhoids （PPH） in treatment for mixed hemorrhoids via a multicenter clinical study. MethodsTwo hundred and fortysix patients with mixed hemorroids were included from four a level of firstclass hospitals, which were averagely divided into shearing fracture ligation combining PPH group, PPH group, and shearing fracture ligation group according to the order of admission. The occurrence status of rectovaginal fistula, urethrorectal fistula, postoperative bleeding, acute urinary retention, anorectal stenosis, and anal incontinence were observed. And the anal function was evaluated by the anorectal pressure measurement. ResultsNo rectovaginal fistula or urethrorectal fistula happened among three groups. No anorectal stenosis happened in the shearing fracture ligation combining PPH group or the PPH group. The score of anorectal stenosis and anal incontinence in these two groups were lower than those in the shearing fracture ligation group (Plt;0.05). The rate of postoperative bleeding in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group (Plt;0.05). There were acute urinary retentions happened among three groups, but without significant differences among them (Pgt;0.05). The anal canal resting pressure after operation was lower than that before operation among three groups (Plt;0.01), which in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group after operation (Plt;0.05). There were no significant differences of the rectum feeling capacity or maximum rectum capacity between the shearing fracture ligation combining PPH group and PPH group before and after operation (Pgt;0.05), but compared with the level before operation in the shearing fracture ligation group, the rectum feeling capacity obviously decreased after operation (Plt;0.05), the maximum rectum capacity obviously increased (Plt;0.05). There were no significant differences of the maxinum anal canal systolic blood pressure between before and after operation in three groups and among three groups (Pgt;0.05). ConclusionsThe operation of shearing fracture ligation combined with PPH can protect the tissue of rectal cushion, remain the normal anatomy structure of anal canal. It has better clinical effect and is much safer than other methods.
目的评价痔上黏膜环切术（PPH)加芍倍注射术治疗中重度（排粪造影检查提示突出深度大于16 mm）直肠前突的疗效。方法回顾性分析我院2006年12月至2010年9月期间应用PPH加芍倍注射术治疗的45例中重度直肠前突患者的临床资料，分析其手术时间、住院时间及复发和并发症发生情况。结果本组患者手术时间为(18.8±2.2) min （15～25 min），住院时间为(7.2±0.6) d (6～8 d)。术后随访(12.3±6.6)个月(6～30个月)。34例(75.6%)排便费力、肛门堵塞、下坠等不适症状完全缓解; 10例(22.2%)症状明显缓解，有轻度肛门下坠感，可忍受; 1例(2.2%)术后排便困难症状缓解，但肛门下坠感明显，6个月后缓解。1例(2.2%)于术后25个月再次出现排便费力症状，排粪造影检查提示直肠前突深度为17 mm(术前34 mm)。45例患者术中及术后均未发生大出血、直肠狭窄、直肠阴道瘘等并发症。结论PPH加芍倍注射术治疗中重度直肠前突具有创伤小、术后恢复快、疗效显著、并发症少等优点，但是患者术后养成良好的排便习惯很重要。
Objective To compare the curative effect of procedure for prolapse and hemorrhoids (PPH) with MilliganMorgan hemorrhoidectomy (MMH) for acute incarcerated hemorrhoids. Methods A retrospective study of 103 patients with acute incarcerated hemorrhoids treated by surgery was performed. The patients were divided into PPH group (n=58) and MMH group (n=45) according to the different operation program who underwent. Operative time, pain score of VAS, time required for anodyne, postoperative complications, hospital stay, and hospital charges were compared. Results The symptoms were both relieved in two groups patients. Although the hospital charges of patients in MMH group were fewer, the patients in PPH group had advantages of shorter operative time, less postoperative pain, lower requirement for anodyne, fewer complications (edema of anal edge), and shorter hospital stay (Plt;0.01). Conclusion PPH is as safe and effective as MMH, and furthermore its short-term therapeutic effect is better than MMH.
目的 比较吻合器痔上黏膜环切术(PPH)与传统痔切除术(Milligan-Morgan，MM)治疗混合痔的临床疗效。方法 200例混合痔患者中行PPH和MM治疗各100例，比较2组患者的疗效及并发症。结果 PPH在疗效及术后并发症发生方面与MM组比较，差异均无统计学意义（P＞0.05）。结论 在治疗混合痔方面PPH不优于MM。
ObjectiveTo compare the efficacy and safety of automatic ligation of hemorrhoids (ALH) and procedure for prolapsed hemorrhoids (PPH) in the treatment of elderly patients with hemorrhoids. MethodsOne hundred and eighty elderly patients with hemorrhoids who were admitted into the First People's Hospital of Jining City from January 2012 to December 2014 were enrolled. According to the operative mode, the patients were divided into ALH group and PPH group, with 90 cases in each group, received ALH and PPH treatment respectively. The postoperative pain, urinary retention, edema, bleeding, infection, anal swelling and anal stenosis were observed in the two groups, and two methods of operation were evaluated in terms of operation time, intraoperative bleeding, postoperative bleeding, postoperative pain, healing time, hospitalization expenses and postoperative complications. ResultsThe VAS scores of the ALH group in the day 1-3 after operation were lower than that of the PPH group, the difference was statistically significant (P < 0.05); the frequency of the use of analgesics in ALH group was less than that in PPH group (P < 0.01); the amount of blood loss and the healing time of the ALH group were significantly less or shoter than those of the PPH group (P < 0.01); the incidence of postoperative urinary retention in the ALH group was 2.22% (2/90), which was significantly lower than that of the PPH group, 27.78% (25/90), the difference was statistically significant (χ2=23.050, P=0.000); the incidence of perianal edema after operation in the ALH group was 5.56% (5/90), which was significantly lower than that of PPH group of 15.56% (14/90), the difference was statistically significant (χ2=4.766, P=0.029). There was no obvious postoperative bleeding in the ALH group(0/90), while the incidence of postoperative bleeding in the PPH group was 7.78% (7/90), and the difference between the two groups was statistically significant (Fisher's exact test, P=0.007). The efficiency of ALH group was 98.89% (89/90) and the PPH group was 97.78% (88/90), the difference between the two groups was not statistically significant (χ2=0.339, P=0.560). Conciusions There is no significant difference between ALH and PPH in the treatment of elderly patients with hemorrhoids, but ALH has the advantages of less pain, quicker recovery and fewer complications, it is worthy of popularization and application.
Objective To compare the clinical effect of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of hemorrhoid in Ⅲ-Ⅳ degree. Methods Clinical data of 80 cases of hemorrhoid in Ⅲ-Ⅳ degree who treated in The First Affiliated Hospital of Harbin Medical University from May 2015 to July 2015 were retrospectively collected. All the 80 cases were divided into TST group (n=40) and PPH group (n=40) according to the surgical types. The comparison of the clinical effect of 2 groups was performed. Results The operative time, hospital stay, intraoperative blood loss, anal fall bilge feeling score, postoperative pain score at 3 time points, and the incidence of anal secretions of TST group were lower or shorter than those corresponding indexes of PPH group (P<0.05). But there was no significant difference in cure rate, the incidence of urinary retention, the incidence of anal stenosis, the incidence of intractable pain, and satisfaction situation between the 2 groups (P>0.05). All of the cases were followed up for 3 months, during the follow-up period, no one suffered from rectal vaginal fistula, fecal incontinence, and recurrence. Conclusion TST and PPH both have satisfactory effect in treatment of hemorrhoid in Ⅲ-Ⅳ degree, but TST has advan- tages of less blood loss, shorter operative time, rapid postoperative recovery, and less pain.
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.