Multiple positioning procedure for prolapse and hemorrhoids in treatment of connective tissue type mixed hemorrhoids / 中国医师进修杂志

ABSTRACT

Objective To explore the effect of multiple positioning procedure for prolapse and hemorrhoids (PPH) in treatment of connective tissue type mixed hemorrhoids,and compare the results between PPH and Milligan-Morgan surgery.Methods One hundred and sixteen patients with connective tissue type mixed hemorrhoids were divided into treatment group (62 cases) and control group (54 cases)according to random digits table method.The patients in treatment group received multiple positioning PPH,and the patients in control group received Milligan-Morgan surgery.The operative time,intraoperative blood loss,postoperative pain score,anal margin edema,wound healing time,perianal scar,anorectal stenosis,anal discharge and anorectal resting pressure were evaluated and compared between 2 groups.Results The operative time and intraoperative blood loss in treatment group were significantly lower than those in control group(15.0 ± 2.3) min vs.(35.0 ± 3.4) min and (5.0 ± 2.1) ml vs.(15.0 ± 3.2) ml,and there were statistical differences (P ＜ 0.05).The postoperative pain score and wound healing time in treatment group were significantly lower than those in control group(4.83 ± 0.62) scores vs.(7.82 ± 0.37) scores and (8.2 ± 2.6) d vs.(17.4 ± 3.8) d,the rates of anal margin edema,perianal scar and anorectal stenosis in treatment group were significantly lower than those in control group8.1％ (5/62) vs.37.0％ (20/54),0 vs.29.6％ (16/54) and 1.6％(1/62) vs.16.7％ (9/54),and there were statistical differences (P ＜ 0.05 or ＜ 0.01).The postoperative anorectal resting pressure was significantly lower than preoperative in control group(13.80 ± 4.20) kPa vs.(17.20 ± 5.87) kPa,and there was statistical difference (P＜ 0.05).One patient (1.6％,1/62) in treatment group occurred anal discharge,and 10 patients (18.5％,10/54) occurred anal discharge in control group.The rate of anal discharge in treatment group was significantly lower than that in control group,and there was statistical difference (P ＜ 0.01).Conclusions Multiple positioning PPH is effective for the treatment of connective tissue type mixed hemorrhoids.It improves the controllability of the amount of removal and the excision site.It decreases the incidence of anal margin edema,perianal scar and anal discharge scar,which provides an effective protection for the anal function.