目的 对痔切除吻合器痔上黏膜环切术（PPH）与传统手术在治疗混合痔环状脱垂或内痔环状脱垂的疗效进行比较。方法 回顾性分析2002年1月至2004年9月西苑医院收治的832例经内镜确诊为内痔及混合痔患者的临床资料。结果 PPH组： 混合痔247例，治愈228例（92.3%），显效19例（7.7%）; 内痔168例均治愈（100%）； 术后发生大出血2例（0.5%），住院时间3.1~6.3 d，无一例创面感染。传统手术组： 混合痔229例中治愈215例（93.9%），显效14例（6.1%）; 内痔188例中治愈175例（93.1%），显效13例（6.9%）； 术后发生出血3例，肛管狭窄12例，并发症发生率为3.6%，住院时间26.2~27.1 d。结论 对痔的环形脱垂，采用PPH手术并与外痔切除或外剥内扎方法相结合，具有手术操作简单、安全、术后疼痛轻、恢复快等特点，优于传统的外剥内扎手术。
目的探讨痔切除吻合器痔上粘膜环切术（PPH）的临床应用价值。方法采用33 mm痔切除吻合器痔上粘膜切除术对严重脱垂性痔30例进行治疗。结果全组病例平均手术时间10分钟，术后住院时间1～3天，脱出痔块均回缩，切除直肠粘膜完整率达98%，术后90%的患者无肛门疼痛，随访3个月，28例满意，2例基本满意。结论采用痔切除吻合器痔上粘膜环切术治疗严重脱垂性痔是一种新技术，其手术操作简单，具有安全、有效、手术时间短、术后疼痛轻、恢复快等特点，有望替代传统的治疗方法。
Objective To investigate clinical effects of modified Xiaozhiling injection with anal cushion suspensory fixation in treatment of prolapsed hemorrhoids. Methods From January 2012 to June 2013, 150 hospitalized patients with Ⅱ and Ⅲ degrees internal hemorrhoids and mixed hemorrhoid, with prolapsing as the main clinical manifestations, were included prospectively, then subsequently randomly divided into a modified Xiaozhiling injection with anal cushion suspensory fixation group (observation group), a procedure for prolapse and hemorrhoids (PPH) group, and a classic Milligan-Morgan surgery (M-M) group. The Xiaozhiling injection with saline by 1:1 mixture was injected into the rectum submucosa and perirectal gap and the anal cushion suspensory fixation were performed for the treatment of prolapsed hemorrhoids in the observation group. The operations of the PPH group and M-M group were same as the convention. The treatment effect, hospitalization time, hospital expenses, postoperative complications, and recurrence were compared among these 3 groups. Results ① Fourty-nine cases were cured and 1 case was improved in the observation group, 48 cases were cured and 2 cases were improved in the PPH group, 48 cases were cured and 2 cases were improved in the M-M group, the treatment effects had no significant differences among these 3 groups (χ2=0.411, P=0.814). ② The hospitalization time and hospitalization expenses of the observation group were significantly less than those of the PPH group (P<0.001) and the M-M group (P<0.001). ③ No prolapse of hemorrhoids and infection happened on day 1, 2, 3, 7, and 14 among these 3 groups. The pains of the observation group were slighter on day 1, 2, 3, 7, and 14 as compared with the PPH group (except on day 14,P<0.05) and the M-M group (P<0.05). The anus bulges had no significant difference between the observation group and the PPH group (except on day 1,P>0.05), which of the observation group were significantly slighter than those of the M-M group (P<0.05). The bleeding on day 2 and 3 and the perianal edema on day 3 had no significant difference between the observation group and the PPH group (P>0.05), which of the observation group were significantly slighter than those of the M-M group (P<0.05). The urinary retention had no significant difference on day 1–3 among these 3 groups (P>0.05). ④ The anal stenosis, anal continence, and hemorrhoids recurrence on month 1, 6, and 12 had no significant differences among these 3 groups (P>0.05). Conclusions Modified Xiaozhiling injection with anal cushion suspensory fixation in treatment of prolapsed hemorrhoids could effectively make anal cushion fixation, eliminate main symptoms of bleeding and prolapse, preserve anal function well. It’s clinical efficacy is same as PPH and M-M methods, with a shorter hospitalization time, less hospitalization expenses, milder postoperative complications, and lower recurrence rate.