ObjectiveTo observe the therapeutic efficacy of ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation for the treatment of four degree mixed hemorrhoids. MethodsThe 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. ResultsA 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). ConclusionFrom 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.
ObjectiveTo explore the analgesic effect of local infiltration anesthesia with liposome bupivacaine (LB) after Milligan-Morgan hemorrhoidectomy through a multicenter, double-blind, randomized controlled study. MethodsA prospective study was conducted on 240 patients with mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou Hospital for Largeintestinal and Anal Diseases, and Puyang People’s Hospital between December 2023 and June 2024. Patients were randomly divided into an observation group (receiving liposome bupivacaine injection) and a control group (receiving methylene blue injection) using a random number table. Postoperative outcomes including pain (VAS) scores, insomnia scores, postoperative edema, urination, time to first defecation, pain during first defecation, perianal sensory recovery time, hospital stay, need for additional analgesic medication, and postoperative complications were compared between the two groups. ResultsAmong 240 patients, 238 completed the study and were included in the analysis, with 119 patients in the observation group and 119 in the control group.① There were no statistically significant differences in baseline characteristics between the two groups (P>0.05).② Postoperative anal pain scores at 6 h, 12 h, 24 h, 48 h, 72 h, and 5 days were lower in the observation group than in the control group (P<0.05).③ Postoperative insomnia scores on days 1, 2, 3, and 5 were lower in the observation group compared with the control group (P<0.05).④ Postoperative edema scores on days 3, 5, and 7 were lower in the observation group than in the control group (P<0.001).⑤ The observation group showed superior outcomes compared to the control group in the following parameters: postoperative 24-hour urination score [0 points vs. 0 points, Z=–2.528, P=0.011]、time to first defecation [2 days vs. 2 days, Z=–2.638, P=0.008]、pain score at first defecation [3 points vs. 5 points, Z=–2.528, P<0.001]、time to recovery of perianal sensation [2 days vs. 1 day, Z=–4.977, P<0.001]、hospital stay duration [6 days vs. 11 days, Z=–12.170, P<0.001]、supplemental analgesic medication need at 7 days postoperation [20.1% vs. 80.7%, χ2 = 87.132, P<0.001]. No statistically significant differences were observed between the two groups in the incidence of complications such as:postoperative nausea [6.7% vs. 8.4%, χ2 = 0.240, P=0.624]、vomiting [5.0% vs. 7.6%, χ2 = 0.640, P=0.424]、dizziness [1.7% vs. 4.2%, χ2=1.325, P=0.250]. ConclusionsLocal infiltration anesthesia with LB after Milligan-Morgan hemorrhoidectomy significantly reduces postoperative pain, insomnia, and edema, shortens hospital stays, and accelerates postoperative recovery. LB demonstrates broad clinical application potential.