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Objective To investigate the clinical efficacy of hemorrhoids suppositories plus fumigation and hip bath with Chinese medicine on postoperative pain and edema of patients with mixed hemorrhoids.Methods A total of 62 cases of mixed hemorrhoids to be treated surgically were randomly divided into the trial group and the control group,with 31 cases in each group.Both groups of patients were given the surgery of mixed hemorrhoids(high ligation of hemorrhoids or Milligan-Morgan hemorrhoidectomy)and routine postoperative nursing.Additionally,the control group was treated with rectal hemorrhoids suppository,and the trial group was treated with rectal hemorrhoids suppository plus fumigation and hip bath with Chinese medicines of Carthami Flos,Persicae Semen,Corydalis Rhizoma,Talcum,Toosendan Fructus,Aurantii Fructus,Phellodendri Chinensis Cortex,Myrrha,and Olibanum.The course of treatment for the two groups covered 2 weeks.The changes of pain score and edema score in the two groups were observed before and after treatment,and time for the relief of the symptoms,clinical efficacy and therapeutic satisfaction were also compared.Results(1)After 2 weeks of treatment,the total effective rate of the trial group was 96.77%(30/31),and that of the control group was 80.65%(25/31).The intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the trial group was significantly superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,the pain scores and edema scores of patients in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of the scores in the trial group was significantly superior to that in the control group with statistically significant difference(P＜0.01).(3)The time for pain relief and time for edema subsidence in the trial group were significantly shorter than those of the control group,and the differences were statistically significant(P＜0.01).(4)The total satisfaction rate of the trial group was 96.77%(30/31),while that of the control group was 77.42%(24/31).The intergroup comparison(tested by chi-square test)showed that the therapeutic satisfaction of the trial group was significantly superior to that of the control group,and the difference was statistically significant(P＜0.05).Conclusion The therapeutic effect of hemorrhoids suppository plus fumigation and hip bath with Chinese medicine in treating postoperative pain and edema of mixed hemorrhoids is remarkably,and the therapy can effectively improve the degree of edema and pain,promote the recovery of the patients,and improve the patient's therapeutic satisfaction.
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Objective:To systematically evaluate the clinical efficacy of Ruiyun procedure for hemorrhoids(RPH)combined with milligan-morgan hemorrhoidectomy(MMH)in the treatment of mixed hemorrhoids compared with MMH alone.Methods:Relevant literature was retrieved from China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases from their establishment to Jan 2023 using computers.Clinical randomized controlled trials(RCTs)of RPH combined with MMH and MMH alone in the treatment of mixed hemorrhoids were selected and analyzed,and meta-analysis was conducted using RevMan5.3 software.Results:A total of 30 RCTs were included,involving 4 609 patients.Results of Meta-analysis showed that there were statistically significant differences in surgical efficacy(RR=1.05,95% CI:1.02-1.08,P= 0.003),postoperative margin edema(RR=0.36,95% CI:0.27-0.49,P＜0.01),postoperative anal pain(RR=0.35,95% CI:0.23-0.53,P＜0.01),postoperative rectal bleeding(RR=0.35,95% CI:0.17-0.72,P=0.004),postoperative anal stenosis(RR=0.26,95% CI:0.11-0.59,P=0.001)and postoperative urinary retention(RR=0.77,95% CI:0.63-0.93,P=0.007)between RPH combined with MMH group and MMH group.Conclusion:Compared with MMH alone,RPH combined with MMH in the treatment of mixed hemorrhoids can reduce the incidence of postoperative side effects,such as postoperative margin edema,anal pain,rectal bleeding,anal stenosis,and urinary retention,with a relatively higher efficiency.
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OBJECTIVE@#To compare the effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy.@*METHODS@#A total of 120 patients with mixed hemorrhoids were randomly divided into an electroacupuncture group A (dilatational wave, 2 Hz/100 Hz in frequency), an electroacupuncture group B (continuous wave, 2 Hz in frequency) and an electroacupuncture group C (continuous wave, 100 Hz in frequency), 40 cases in each group. Electroacupuncture at Xialiao (BL 34) and Chengshan (BL 57) was applied with tolerant intensity for 30 min before operation in all groups. The number of additional anesthetic drugs in the 3 groups, the visual anal pain score (VAS) and limb activity score at 4, 12, and 24 h after operation, the maximum VAS score within 24 h after surgery and oral dose of aminophenol dihydrocodeine were compared.@*RESULTS@#The number of additional anesthetic drugs in the electroacupuncture group A, the electroacupuncture group B and the electroacupuncture group C were 4, 5, 4 respectively, and there was not statistically significant (>0.05). There was no significant difference in the anal pain VAS score and limb activity score at 4 h after operation among the 3 groups (>0.05), at the 12 h after operation, the VAS scores and limb activity scores in the electroacupunctures group A and B were lower than those in the electroacupuncture group C (<0.05), at 24 h after operation, the VAS score and limb activity score in the electroacupuncture group A were lower than those in the electroacupuncture group B and C (<0.05), the maximum VAS score within 24 h and oral dose of aminophenol dihydrocodeine within 24 h after operation in the electroacupuncture group A were lower than those in the electroacupuncture group B and C (<0.05).@*CONCLUSION@#Different frequency electroacupuncture preconditioning has the effect of alleviating anal pain after milligan-morgan hemorrhoidectomy. The analgesic effect of electroacupuncture with different frequencies is different. The electroacupuncture analgesic effect of 2 Hz /100 Hz dilatational wave is better than 2 Hz and 100 Hz continuous waves.
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Humanos , Canal Anal , Eletroacupuntura , Hemorroidectomia , Hemorroidas , Terapêutica , Dor PélvicaRESUMO
OBJECTIVE@#To investigate the effect of electroacupuncture preconditioning combined with induced urination on urinary retention after milligan-morgan hemorrhoidectomy.@*METHODS@#Eighty patients with mixed hemorrhoids were randomly divided into an electroacupuncture group and a routine group, 40 cases in each group. Anesthesia at Yaoshu (GV 2) was given in the two groups. In the electroacupuncture group, electroacupuncture at Zhongji (CV 3)，Guanyuan (CV 4)，Pangguangshu (BL 28) and Sanyinjiao (SP 6) was applied with tolerant intensity for 30 min before operation, 2 Hz/100 Hz in frequency. After operation, induced urination was given, namely hot compress of bladder area and sound of hearing water. In the routine group，induced urination was given after operation. The score of the first urination waiting time, the distension of lower abdomen on the evening of the postoperative, the first time urinary volume and incidence of urinary retention were compared between the two groups.@*RESULTS@#The scores of the first urination waiting time after operation and distension of lower abdomen in the evening of the postoperative in the electroacupuncture group were lower than those in the routine group, the first time urinary volume was more than that in the routine group, and the incidence of urinary retention was lower than that in the routine group (5.0% (2/40) vs 22.5% (9/40), all <0.05).@*CONCLUSION@#Electroacupuncture preconditioning combined with induced urination can effectively prevent the incidence of urinary retention after milligan-morgan hemorrhoidectomy.
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Humanos , Eletroacupuntura , Hemorroidectomia , Hemorroidas , Retenção Urinária , Terapêutica , MicçãoRESUMO
Objective To observe the curative effect of abdominal acupuncture on postoperative pain of patients with mixed hemorrhoid after Milligan-Morgan hemorrhoidectomy.Methods A total of 100 mixed hemorrhoid patients with postoperative pain after Milligan-Morgan hemorrhoidectomy under spinal anaesthesia from September of 2014 to December of 2015 were included into the study.The patients were evenly randomized into trial group and control group.The trial group was treated with abdominal acupuncture at acupoints of Shuifen,Guanyuan,Qihai,Sanxing needles under Qihai,lower Fengshi,Tianshu for 15-30 min.The control group was treated with intramuscular injection of Tramadol Injection 0.1 g.Before treatment and 0.5,1,2,3 hours after treatment,the pain visual analogue scale (VAS) scores and body activity scores were recorded.Results (1) After treatment,pain VAS scores of the two groups at different time points were obviously decreased(P ＜ 0.05 compared with those before treatment),and the decrease of pain VAS scores of the treatment group 0.5 hours after treatment was superior to that of the control group (P ＜ 0.05),but there was no significant difference between the two groups at other time points (P ＞ 0.05).(2) After treatment,body activity scores of the two groups at different time points were obviously decreased(P ＜ 0.05 compared with those before treatment),but the difference was insignificant between the two groups(P＞ 0.05).(3) The average dose of Tramadol Injection used in the trial group was 0.013 ± 0.034 1 g,while was 0.103 ± 0.017 7 g in the control group,the difference being significant (P ＜ 0.05).Conclusion The analgesic effect of abdominal acupuncture is similar to that of Tramadol Injection.For its safety,and being cheap,practical and painless,abdominal acupuncture can be expected to be another option of effective analgesic method for the postoperative pain of patients with mixed hemorrhoid after Milligan-Morgan hemorrhoidectomy.
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Background: Haemorrhoidectomy remains the treatment of choice for symptomatic grade-III and IV hemorrhoids. Milligan and Morgan’s haemorrhoidectomy is the most widely used procedure in the surgical management of hemorrhoids. Aim: This study was done to evaluate and analyze statistically whether stapler haemorrhoidectomy is better than Milligan Morgan haemorrhoidectomy in terms of Post operative pain, Duration of Hospital stay. Materials and methods: Prospective analytical study of 124 patients of haemorrhoids Grade II to Grade IV admitted , all adults aged 18 to 75 years with grade II to grade IV haemorrhoids admitted with ASA GRADE < III were included in our study. Two groups were constituted a stapled haemorrhoidectomy group and a Milligan Morgan group operated using standard open haemorrhoidectomy. Pain was assessed and recorded at 0, 15, 30, 45, 60 minutes after the patient attains a score of 4/4 on Bromage scale. Pain was assessed using visual analogue scale (VAS). K Tirumala Prasad, R V Apparao. Stapler hemorrhoidectomy versus Milligan Morgan hemorrhoidectomy in hemorrhoids in terms of post-operative pain and hospital stay - A prospective randomized control trial. IAIM, 2016; 3(12): 59-67. Page 60 Results: It was observed that at 0 minutes out of 62 patients in Milligan Morgan group 47 patients had moderate pain, 15 had mild pain. (mean VAS score was 4.242), at 15 minutes out of 62 patients in Milligan Morgan group 38 patients had moderate pain, 24 had mild pain (mean VAS score was 3.82). At 30 minutes out of 62 patients in Milligan Morgan group 25 patients had moderate pain 37 had mild pain (mean VAS score was 3.50).At 45 minutes out of 62 patients in Milligan Morgan group 19 patients had moderate pain 43 had mild pain (mean VAS score 3.342). At 60 minutes out of 62 patients in Milligan Morgan group 14 patients had moderate pain 48 had mild pain.(mean VAS score 3.016)/ In the stapler group the VAS scale at the same intervals were 1.712, 1.06, 0.966, 0.647, and 0.407 respectively. At all the intervals the P value was <0.005. Thus establishing the fact that stapler haemorrhoidectomy is less painful procedure than Milligan Morgan hemorrhoidectomy. The mean duration of hospital stay in the Milligan Morgan group was 2.532 days and stapler haemorrhoidectomy was 1.136 days with a P value <0.005. Conclusion: The circular stapled procedure for haemorrhoids is superior in terms of postoperative pain, discomfort, anaesthesia time and return to normal activity.
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Objective To compare the effect of procedure prolapse hemorrhoids (PPH)and traditional milligan morgan hemorrhoidectomy in treatment of circumferential mixed hemorrhoids. Methods All 60 cases annular mixed hemorrhoid patients were randomly divided into observation group and control group,each group 30 cases, observation group un-derwent the procedure for prolapse and hemorrhoids,the control group underwent milligan morgan hemorrhoidectomy,op-erative time, bleeding, hospitalization time, VAS, complications were compared between two groups. Results The mean operative time, hospitalization time of observation group was significantly shorter than the control group,intra-operative bleeding volume was less than the control group (P<0.05), after operation 24 h, VAS of observation group decreased more significantly than the control group(P<0.05),the complication rate in the observation group was 13.3%,was lower than the control group 40.0%(P<0.05). Conclusion The procedure for prolapse and hemorrhoids than tradi-tional milligan morgan hemorrhoidectomy has advantages of less bleeding, shorter operative time, less postoperative complications,less pain,worthy of promotion and application.
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Objective To explore the effect of Chitosan gel (Ⅲ) on the complications from Milligan-Morgan hemorrhoidectomy for treatment of severe mixed hemorrhoids.Methods Seventy-six patients with severe mixed hemorrhoids were randomly divided into treatment group and control group with 38 cases in each group. All patients from the two groups were treated with Milligan-Morgan hemorrhoidectomy. Then Chitosan gel (Ⅲ) was used in the treatment group. The two groups were compared in terms of curative effect, pain level, complications and hospital stay.Results There was no significant difference in the curative effect (P>0.05). But the scores on pain level, hemtochezia, infection and edema of the treatment group were all significantly lower than those of the control group (allP<0.05) and the hospital stay was significantly shorter than that of the control group (P<0.05).Conclusions In the treatment of severe mixed hemorrhoids by Milligan-Morgan hemorrhoidectomy, Chitosan gel (Ⅲ) is effective in relieving pains, reducing hemorrhage, edema and preventing infections and therefore shortens the hospital stay. In view of nursing, it is critical to perform mental care as well as close observations on complications.
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Objective To compare the clinical outcome of procedure for prolapse and hemorrhoids (PPH) and PPH + selective Milligan-Morgan hemorrhoidectomy(MMH) in surgical treatment of Ⅲ ～ Ⅳ stage hemorrhoids and research the best surgical procedures.Methods Retrospective analysis was made on the clinical data of 125 cases with Ⅲ ～ Ⅳ stage mixed hemorrhoids,they were non-randomized-controlled divided into PPH group (group 1) and PPH + selective MMH group(group 2),comparing the data of recurrence,complication and symptoms relief including anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.Results While observing 3 years after operation,group 1 and group 2 both relieved symptoms of anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.The relief rate of these symptoms in the two group were all high than 92%.There was one cases relapsed in the group 2 (the recurrence rate of 2%) was better than the group 1 (the recurrence rate of 13%) which were 8 case,there was a significant statistical significance (x2 =4.629,P ＜ 0.05) in the recurrence and clinical outcome.Conclusion Radical choose of PPH and selective MMH to treat Ⅲ ～ Ⅳ stage mixed hemorrhoids patients,which could relieve postoperative symptoms and acquire better long-term clinic outcomes.
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Objective To demonstrate the feasibility, effectiveness and reliability of combination of procedure for prolapse and hemorrhoids (PPH) and excision-closed hemorrhoidectomy (ECH) for severe hemorrhoids. Methods Sixty patients with Ⅲ- Ⅳ degree hemorrhoids which left remnant prolapsed hemorrhoids after stapled hemorrhoidopexy, were randomly divided into group A (PPH with additional ECH group,30 cases.) and group B [PPH with additional Milligan-Morgan hemorrhoidectomy (MMH) group, 30 cases]. Ten indexes of the results in two groups were compared. ResultsThe hemorrhoidectomy lasted (35.6 ± 5.3) min in group A and (47.3 ± 10.2) min in group B. The indexes related to 24 h visual analogue scale (VAS) after operation were (2.9 ± 1.2) scores in group A and (5.7 ± 1.9) scores in group B. Wound healing time were (6.3 ± 1.4) d in group A and (28.5 ± 4.8) d in group B. Many indexes showed the results in group A was better than those in group B ( P ＜ 0.05 ). The six-month follow-up visits after operation showed no complications, such as recurrence in either group. ConclusionsCombination treatment for Ⅲ -Ⅳ degree hemorrhoids with PPH with additional ECH is a easy,safe,reliable,minimal-aching and quick-recovering method of hemorrhoidectomy with favorable results than PPH with additional MMH.
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Objective To compare the long-term effects between procedurefor prolapse and hemorrhoids(PPH) and Milligan-Morgan hemorrhoidectomy( MMH ) in the treatment of Ⅲ and Ⅳ degree of hemorrhoids. Method The clinical data of 43 cases with Ⅲ and Ⅳ degree hemorrhoids received PPH (PPH group)and 71 cases received MMH (MMH group) were analyzed retrospectively from October 2001 to July 2003. Results Late bleeding in 5 cases of PPH group and no one of MMH group (P ＜0.05).Hemorrhoidal recurrence prolapsed in 9 cases of PPH group and 5 cases of MMH group (P ＜ 0.05). The rectal neck pressure preoperative,after 6 months, 1 year and 3 years were (122.0 ± 11.3), (90.0 ± 10.4),(103.0 ± 13.8) and (113.0 ± 11.2) cm H2O (1 cm H2O =0.098 kPa) of PPH group,after 6 months was decreased obviously than preoperative (P＜0.05),and they were ( 126.0 ± 13.5), (91.0 ± 12.4), (78.0 ±9.8) and (81.0 ± 7.5 ) cm H2O of MMH group,after 6 months, 1 year and 3 years were decreased obviously than preoperative (P ＜ 0.05). Conclusion PPH is safety and effect at short time,but it brings more late bleeding and anal pain,and its rate of prospective hemorrhoidal recurrence is more higher than MMH.