Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids: A retrospective study.

BACKGROUND: Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery. They are venous clusters formed by congestion, expansion, and flexion of the venous plexus in the lower part of the rectum. Mixed hemorrhoids bleed easily and recurrently, and this can result in severe anemia. Hence, they may have a negative effect on the health of the patient and surgical treatment is required. Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids. However, most patients experience different degrees of postoperative pain that may cause anxiety. AIM: To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery. METHODS: The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively. The basic characteristics of the enrolled patients with mixed hemorrhoids were recorded, and based on the Goligher clinical grading system, the hemorrhoids were classified as grades III or IV. The endpoint of this study was the disappearance of pain in all patients. Quantitative data were presented as mean ± SD, such as age, pain score, and QoL score. Student's t-test was used to compare the groups. RESULTS: A total of 164 patients were enrolled. The distribution of the visual analog scale pain scores of all patients at 3, 7, 14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time. Fourteen days after the operation, the pain had completely disappeared in some patients. Twenty-eight days after the surgery, none of the patients experienced any pain. Comparing the World Health Organization Quality of Life - BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery, we observed that the quality-of-life scores of the patients post-surgery had significantly improved. There were six items that were compared at 14- and 28-d post-surgery. The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57). The mean health condition score 28 d after surgery (4.80 ± 0.41) was also higher than that at 14 d post-surgery (4.01 ± 0.62). The mean physical health score 28 d after surgery (32.10 ± 2.96) was significantly higher than that at 14 d post-surgery (23.41 ± 2.85). The mean psychological health score 28 d after surgery (27.22 ± 1.62) was significantly higher than that at 14 d post-surgery (21.37 ± 1.70). The mean social relations score 28 d after surgery (12.21 ± 1.59) was significantly higher than that at 14 d post-surgery (6.32 ± 1.66). The mean surrounding environment score 28 d after surgery (37.13 ± 2.88) was significantly higher than that at 14 d post-surgery (28.42 ± 2.86). The differences in quality-of-life scores at day 14 and day 28 post-surgery were observed to be statistically significant (P < 0.001). CONCLUSION: Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients. Age, sex, and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.

[Effect of electroacupuncture at different time points on postoperative urination function in patients with mixed hemorrhoids surgery].

OBJECTIVE: To observe the effect of preoperative, intraoperative and postoperative electroacupuncture (EA) intervention on postoperative urination function in patients with mixed hemorrhoid surgery. METHODS: A total of 240 patients with mixed hemorrhoid surgery under lumbar anesthesia were randomly divided into an EA preconditioning group (group A, 60 cases, 9 cases dropped off), an intraoperative EA group (group B, 60 cases, 4 cases dropped off), a postoperative EA group (group C, 60 cases, 6 cases dropped off), and a non-acupuncture group (group D, 60 cases, 3 cases dropped off). In the groups A, B and C, EA was exerted at Zhongliao (BL 33) and Huiyang (BL 35) , with disperse-dense wave, 4 Hz/20 Hz in frequency, and lasting 30 min, at 30 min before lumbar anesthesia, immediately after lumbar anesthesia and 6 h after surgery, respectively. No EA intervention was performed in the group D. The postoperative urination smoothness score in each group was observed 24 h after surgery. The first urination time, first urination volume, urine residual volume after first urination were recorded, and incidence of indwelling catheterization, postoperative visual analogue scale (VAS) score, number of remedial analgesia, and the incidence of postoperative nausea and vomiting were observed in each group. RESULTS: In the groups A, B and C, the postoperative urination smoothness scores were superior to the group D (P<0.05), and the time of first urination was earlier than the group D (P<0.05). In the group C, the time of first urination was earlier than the group A and the group B (P<0.05), the first urination volume was higher than the group D (P<0.05), and the urine residual volume after first urination was lower than the group D (P<0.05). There was no significant difference in the incidence of indwelling catheterization and postoperative nausea and vomiting among the 4 groups (P>0.05). The VAS scores of the group A, B and C were lower than that in the group D (P<0.05), and the number of remedial analgesia cases was lower than that in the group D (P<0.05). CONCLUSION: EA intervention could promote the recovery of urination function and relieve postoperative pain in patients with mixed hemorrhoids surgery. Early postoperative EA intervention is more conducive to the recovery of urination function.

Effect of electroacupuncture at different time points on postoperative urination function in patients with mixed hemorrhoids surgery / 中国针灸

OBJECTIVE@#To observe the effect of preoperative, intraoperative and postoperative electroacupuncture (EA) intervention on postoperative urination function in patients with mixed hemorrhoid surgery.@*METHODS@#A total of 240 patients with mixed hemorrhoid surgery under lumbar anesthesia were randomly divided into an EA preconditioning group (group A, 60 cases, 9 cases dropped off), an intraoperative EA group (group B, 60 cases, 4 cases dropped off), a postoperative EA group (group C, 60 cases, 6 cases dropped off), and a non-acupuncture group (group D, 60 cases, 3 cases dropped off). In the groups A, B and C, EA was exerted at Zhongliao (BL 33) and Huiyang (BL 35) , with disperse-dense wave, 4 Hz/20 Hz in frequency, and lasting 30 min, at 30 min before lumbar anesthesia, immediately after lumbar anesthesia and 6 h after surgery, respectively. No EA intervention was performed in the group D. The postoperative urination smoothness score in each group was observed 24 h after surgery. The first urination time, first urination volume, urine residual volume after first urination were recorded, and incidence of indwelling catheterization, postoperative visual analogue scale (VAS) score, number of remedial analgesia, and the incidence of postoperative nausea and vomiting were observed in each group.@*RESULTS@#In the groups A, B and C, the postoperative urination smoothness scores were superior to the group D (P<0.05), and the time of first urination was earlier than the group D (P<0.05). In the group C, the time of first urination was earlier than the group A and the group B (P<0.05), the first urination volume was higher than the group D (P<0.05), and the urine residual volume after first urination was lower than the group D (P<0.05). There was no significant difference in the incidence of indwelling catheterization and postoperative nausea and vomiting among the 4 groups (P>0.05). The VAS scores of the group A, B and C were lower than that in the group D (P<0.05), and the number of remedial analgesia cases was lower than that in the group D (P<0.05).@*CONCLUSION@#EA intervention could promote the recovery of urination function and relieve postoperative pain in patients with mixed hemorrhoids surgery. Early postoperative EA intervention is more conducive to the recovery of urination function.

Progress of suspension in the treatment of severe mixed hemorrhoids / 国际外科学杂志

The incidence of severe mixed hemorrhoids is increasing year by year, and its surgical method has always been the focus in the study of anoenterology. On the basis of anal cushion downward movement theory, anal cushion suspension surgery moves up prolapsed anal cushion by suturing or ligating the mucosa above the dentate line. This not only ensures the effect of surgical treatment, but also protects the structure and function of the canal and anus in the most fine, which is in line with the minimally invasive treatment idea of severe mixed hemorrhoids, and is gradually widely used in clinical practice. As a new surgical method, anal cushion suspension surgery has unique advantages in treating severe mixed hemorrhoids, especially in severe prolapsed hemorrhoids. This paper will analyse the key points of anal cushion suspension surgery combined with procedure for prolapse and hemorrhoids, milligan morgan, hemorrhoidal artery ligation, automatic ligation of hemorrhoids, injection sclerotherapy, laser ablation and mixed surgeries respectively, in order to provide reference for clinicians to operate on severe mixed hemorrhoids.

Effects of Huhuang Burn Liniment on wound healing and changes in IL-10 and MMP-9 levels in patients with mixed hemorrhoids.

OBJECTIVE: To explore the effects of Huhuang Burn Liniment on wound healing and levels of interleukin-10 (IL-10) and matrix metalloproteinase-9 (MMP-9) in patients with mixed hemorrhoids. METHODS: The clinical data of 113 patients with mixed hemorrhoids admitted to Chongqing Sanxia Central Hospital were retrospectively collected. All patients underwent Milligan-Morgan hemorrhoidectomy, and were divided into two groups according to different postoperative treatments. Group A was treated with 1/5000 potassium permanganate sitz bath after surgery, while group B was treated with Huhuang Burn Liniment. The treatment efficacy, wound healing time, level of pain, exudation, edema, granulation scores, anal function index, levels of IL-10 and MMP-9, quality of life scores, and complications were compared between the two groups. RESULTS: The effective rate of group B (94.74%) was higher than that of group A (60.71%) (P < 0.05). Group B had shorter length of anorectal hyperbaric zone, higher anal canal resting pressure, anal canal diastolic pressure, and anal canal systolic maximum pressure (P < 0.05), lower scores of trauma pain, edema, exudation, and granulation (P < 0.05), higher IL-10 levels, and lower MMP-9 levels (P < 0.05). The complication rate of group B (8.77%) was lower than that in group A (23.21%) (P < 0.05). After treatment, group B had shorter wound healing time and higher quality of life score than group A (P < 0.05). CONCLUSION: The application of Huhuang Burn Liniment in patients with mixed hemorrhoids after surgery could promote wound healing and anal function, reduce trauma pain, exudation and edema, and improve quality of life.

Analysis of the status quo of early postoperative pain belief in patients with mixed hemorrhoids and its influencing factors / 中国实用护理杂志

Objective:To investigate the current situation of early postoperative pain beliefs in patients with mixed hemorrhoids and its influencing factors, and to provide a basis for formulating targeted intervention measures.Methods:Totally 242 postoperative patients with mixed hemorrhoids who were treated in Guilin Integrated Traditional Chinese and Western Medicine were selected by convenience sampling method from January 2020 to January 2021 as the research object. The general information questionnaire, Pain Belief and Perception Scale, Visual Analogue Scale, Positive and Negative Emotion Scale were used to investigate. Multiple linear regression was used to analyze the factors influencing of early postoperative pain beliefs in patients with mixed hemorrhoids.Results:The total score of early postoperative pain belief in patients with mixed hemorrhoids was -21-30 (5.32 ± 2.57) points; the results of multiple linear regression analysis showed that age, education level, anal visual analogue score, and negative emotion scores were main factors affecting their pain beliefs ( r=0.736, P<0.05). Conclusions:Patients with mixed hemorrhoids have negative pain beliefs in the early postoperative period. Patients with advanced age, primary/junior high school, high anal pain intensity, and high negative emotion scores are more likely to have negative pain beliefs. Nursing staff should promptly formulate targeted intervention measures according to the main influencing factors in order to reduce the occurrence of negative beliefs about pain.

Qualitative study of pain catastrophic experience of patients after mixed hemorrhoid surgery / 中国实用护理杂志

Objective:To deeply understand the pain perception and experience of patients after mixed hemorrhoid surgery, so as to provide reference for taking targeted intervention measures to relieve pain symptoms.Methods:Purpose sampling method was used to conduct semi-structured in-depth interviews with 9 patients with postoperative pain of mixed hemorrhoids admitted to Guilin Hospital of Integrated Traditional Chinese and Western Medicine from February to March 2021, and Colaizzi phenomenological analysis method was used to analyze data and refine themes.Results:The pain perception and experience of patients after mixed hemorrhoid surgery can be summarized into 5 themes: fear of pain, persistent negative thinking about pain, perception of inability to cope with pain, emotional expectation, and expectation of Traditional Chinese Medicine nursing techniques.Conclusions:Patients after mixed hemorrhoid surgery have many burdens and needs in terms of pain experience. Medical staff must establish a complete pain management system for patients after mixed hemorrhoid surgery, aiming at the catastrophic pain experience of patients, correcting their cognitive level of pain management, and satisfying patients Alleviate the need for pain, establish an effective emotional and family support system, improve its pain self-management ability, and promote postoperative recovery.

Influences of Hiao's double-C nursing model combined with pain care on postoperative satisfaction with pain control and complications in patients with mixed hemorrhoids.

OBJECTIVE: To explore the influences of Hiao's double-C nursing model combined with pain care on postoperative satisfaction with pain control and complications in patients with mixed hemorrhoids. METHODS: A total of 80 patients with mixed hemorrhoids admitted to our hospital from January 2019 to October 2020 were selected as the study subjects, and they were divided into a regular group (n = 43) and a combined group (n = 37) based on different nursing methods. The regular group was treated with routine nursing care, while the combined group was treated with Hiao's double-C nursing model combined with pain care. The degrees of pain, duration of pain, satisfaction with pain control, quality of life and complications were compared between the two groups. RESULTS: At 6 h, 24 h and 72 h after surgery, the combined group had markedly lower visual analogue scale (VAS) scores and a noticeably shorter duration of pain than that of the regular group (P < 0.05). Compared with the regular group, the combined group scored significantly lower on pain experience and expectation, and influences of pain on emotions, body and life, and significantly higher on satisfactions with pain control education and pain control or relief and overall satisfaction (P < 0.05). After intervention, the scores of quality of life, and physical, social and psychological functions were elevated in both groups (P < 0.05), and the aforementioned scores in the combined group were significantly higher than those in the regular group (P < 0.05). The incidence rate of complications in the combined group was notably lower than that in the regular group (8.11% vs. 41.86%, P < 0.05). CONCLUSION: Hiao's double-C nursing model combined with pain care can effectively improve postoperative degrees of pain, satisfaction with pain control and complications, and duration of pain.

The effects of modified Buzhong Yiqi decoction combined with Gangtai ointment on the wound healing and anal function in circumferential mixed hemorrhoid patients.

OBJECTIVE: To investigate the effects of modified Buzhong Yiqi decoction combined with Gangtai ointment on the wound healing and anal function of circumferential mixed hemorrhoid patients. METHODS: Patients (n=120) with circumferential mixed hemorrhoids were recruited as the research cohort. All the patients underwent surgical treatment and were randomly divided into a control group and a research group. The control group was administered chitosan hydrogels for wound healing, once a day. The research group was administered modified Buzhong Yiqi decoction (1 dose a day, orally) combined with Kangtai ointment for external application (twice a day, for two consecutive weeks). We compared the two groups' effective rates, their pain indexes, their perianal edema scores, their quality of life scores, their wound healing times, their pain resolution times, their anal functions, their wound exudate scores, and their adverse reactions. RESULTS: Compared with the control group, the research group had a higher effective rate (P<0.01), a lower pain index, and a lower perianal edema score (both P<0.001), a higher quality of life score (P<0.001), a shorter wound healing time, a shorter pain resolution time, and fewer adverse reactions than the control group (both P<0.001). The lengths of the anal canals in the research group were shorter than they were in the control group (P<0.01), and the resting pressure, maximum diastolic blood pressure, and maximum systolic blood pressure were higher than they were in the control group (all P<0.001). The wound exudate scores at 7 and 14 days after the treatment in the research group were lower than they were in the control group (all P<0.001). There were fewer adverse reactions in the research group than there were in the control group (P<0.05). CONCLUSION: Modified Buzhong Yiqi decoction combined with Gangtai ointment for patients with circumferential mixed hemorrhoids has good short-term efficacy. It helps to promote wound healing, improves anal function, and does not increase the incidence of adverse reactions. It is worthy of promotion and application.

Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids.

OBJECTIVE: To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. METHODS: Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. RESULTS: The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. CONCLUSION: Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.

A new mixed surgical treatment for grades iii and iv hemorrhoids: modified selective hemorrhoidectomy combined with complete anal epithelial retention / Um novo tratamento cirúrgico para hemorroidas mistas graus iii e iv: hemorroidectomia seletiva modificada combinada com retenção epitelial anal completa

ABSTRACT Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. Results: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. Conclusions: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.

RESUMO Racional: Veias varicosas aparecem acima e abaixo da linha dentada nas hemorroidas mistas, afetando seriamente a função anal e a qualidade de vida. Objetivo: Propor melhoria na terapia de seleção de tecido de reparo do coxim anal combinado com retenção completa epitelial do canal anal em comparação com a operação de Milligan-Morgan. Métodos: Estudo prospectivo randomizado controlado foi desenhado envolvendo 200 pacientes com hemorroidas graus III e IV. Eles foram divididos em grupos de controle e observação. O controle recebeu operação de Milligan-Morgan, e o de observação procedimento de seleção de tecido modificado combinado com operação completa de preservação do canal anal. Todos os pacientes foram acompanhados por seis meses para avaliar as diferenças de tratamento. Resultados: No final, o grupo controle incluiu 82 e o de observação 87. O tempo médio de operação do grupo controle foi significativamente menor do que o de observação, enquanto o volume de sangramento foi significativamente menor no grupo controle. O escore VAS do grupo controle foi 3 (1, 4) e no de observação 4 (2, 5). Não houve diferença significativa na incidência de retenção urinária, sangramento e edema da margem da ferida no pós-operatório de um mês. A incidência de estenose anal digital no grupo observação foi significativamente menor do que no controle; o mesmo ocorreu com as margens anais residuais. O diâmetro do canal anal pós-operatório foi significativamente maior nele do que o grupo controle. A pontuação de incontinência anal de Wexner mostrou que nenhuma incontinência ocorreu em ambos os grupos, e a pontuação do grupo de controle foi significativamente maior do que no de observação. Nos últimos seis meses de acompanhamento, o grupo observação não teve nenhuma recaída e quatro casos foram encontrados entre os controles. A satisfação com o tratamento do grupo observação foi maior. Conclusões: Nas hemorroidas graus III e IV, o tratamento de seleção de tecido modificado combinado com a preservação completa do canal anal teve melhor prognóstico e satisfação do que com o procedimento de Milligan-Morgan, e é um novo método cirúrgico para pacientes com hemorroidas mistas avançadas.

[Effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy].

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 (P>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 (P>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 (P<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 (P<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 (P<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.

[Effect of preoperative intervention of electroacupuncture at Baliao point on postoperative complications of procedure for prolapsed and hemorrhoids].

OBJECTIVE: To explore effective treatments that can alleviate postoperative complications in patients with procedure for prolapsed and hemorrhoids (PPH). METHODS: Sixty patients with pre-mixed hemorrhoids PPH were randomly divided into a simple operation group and a preoperative electroacupuncture intervention group, 30 cases in each group. PPH routine treatment was given in the simple operation group. Electroacupuncture (EA) was applied at Baliao point 30 min before PPH in the preoperative electroacupuncture intervention group, and EA was applied at Ciliao (BL 32) and Xialiao (BL 34) for 30 min. The scores of anus pendant, pain degree and persistent time and first urination time were compared within 24 h after operation between the two groups. RESULTS: The scores of anal pendant and pain degree in the 6 h, 12 h, 18 h, the persistent time of anal pendant and pain degree within 24 h and first urination time were better in the preoperative electroacupuncture intervention group than those in the simple operation group, and there were statistically significant differences (all P<0.05). CONCLUSION: Electroacupuncture at Baliao point 30 min before PPH can not only decrease the degrees of anal pendant and pain in the 6 h, 12 h, 18 h, but also shorten the persistent time of anal pendant and pain within 24 h after surgery and promote the first urination.

Effect of preoperative intervention of electroacupuncture at point on postoperative complications of procedure for prolapsed and hemorrhoids / 中国针灸

OBJECTIVE@#To explore effective treatments that can alleviate postoperative complications in patients with procedure for prolapsed and hemorrhoids (PPH).@*METHODS@#Sixty patients with pre-mixed hemorrhoids PPH were randomly divided into a simple operation group and a preoperative electroacupuncture intervention group, 30 cases in each group. PPH routine treatment was given in the simple operation group. Electroacupuncture (EA) was applied at point 30 min before PPH in the preoperative electroacupuncture intervention group, and EA was applied at Ciliao (BL 32) and Xialiao (BL 34) for 30 min. The scores of anus pendant, pain degree and persistent time and first urination time were compared within 24 h after operation between the two groups.@*RESULTS@#The scores of anal pendant and pain degree in the 6 h, 12 h, 18 h, the persistent time of anal pendant and pain degree within 24 h and first urination time were better in the preoperative electroacupuncture intervention group than those in the simple operation group, and there were statistically significant differences (all <0.05).@*CONCLUSION@#Electroacupuncture at point 30 min before PPH can not only decrease the degrees of anal pendant and pain in the 6 h, 12 h, 18 h, but also shorten the persistent time of anal pendant and pain within 24 h after surgery and promote the first urination.

Effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy / 中国针灸

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.

Segmental resection combined with anoplasty for the treatment of circumferential mixed hemorrhoids

Circumferential mixed hemorrhoids are very difficult to treat non-surgically. Therefore, it is important to explore the surgical methods for its complete resolution as well as maintenance of normal anal anatomy and function. The present study was designed to evaluate the effect of segmented and plastic hemorrhoidectomy (SPH) on patients with circumferential mixed hemorrhoids. A total of 300 patients with circumferential mixed hemorrhoids were divided into experimental group (n=150) undergoing SPH and control group (n=150) undergoing Milligan-Morgan hemorrhoidectomy. There were no differences in cure and effectiveness rates between two groups. Compared with the control group, patients in the experimental group had shorter healing time (15.7±1.3 vs 12.5±0.7 days) and recovery to normal activity (18.5±2.7 vs 14.7±1.2 days). In addition, anal function of all patients in the experimental group was normal during short- and long-term follow-up. However, more cases in the control group showed anal dampness and itching, and poor control of intestinal liquid. Compared with the control group, patients in the experimental group had better outcomes in overall anal function and smoothness at 6, 12, and 18 months after operation as well as patient satisfaction. Furthermore, the rating in the visual analogue scale for defecation pain and edema in the experimental group was less than that in the control group. SPH was more effective, had fewer complications, better protection of anal function, and a better cosmetic result.

The clinical effect of RPH combined with Milligan versus that of PPH in treatment of severe mixed hemor-rhoids / 实用医学杂志

Objective To compare the clinical effects of RPH combined with Milligan and PPH in the treatment of severe mixed hemorrhoids. Methods 168 patients with severe mixed hemorrhoids were assigned to a study group or a control group,84 patients for each group. The control group received PPH therapy,while the study group received RPH combined with Milligan procedure. Results The procedures were completed successfully in all the patients. The postoperative hospital stay and surgical duration were shorter and the amount of bleeding was smaller in the study group than in the control group(P<0.05). Three months after surgery,the rate of compli-cations including urinary retention,anal incontinence,anorectal stenosis,and secondary anal fissure was lower in the study group than in the control group(P < 0.05). The total effective rate was 97.6% in the study group and 85.7% in the control group,with a higher rate in the study group(P<0.05). Anal PSV and EDV values were lower in both groups three months after the procedures as compared with one day before the procedures(P<0.05),and the values were smaller in the study group than in the control group(P<0.05). Conclusions Milligan combined with RPH in the treatment of severe mixed hemorrhoids can reduce hemorrhoids blood flow. This procedure is mini-mally invasive and it can reduce the development of postoperative complications and improve efficacy.

[Effect on Postoperative Complications of Mixed Hemorrhoids Treated with Electroacupuncture at Chengshan(BL 57), Dachangshu(BL 25)and Erbai(EX-UE 2)].

OBJECTIVE: To evaluate the effect on postoperative complications of mixed hemorrhoids treated with electroacupuncture(EA) at Chengshan(BL 57)，Dachangshu(BL 25)and Erbai(EX-UE 2). METHODS: A total of 60 patients with mixed hemorrhoids were randomly divided into control and EA groups，30 cases in each group. In addition to basic treatment, EA was applied at BL 57, BL 25 and EX-UE 2 for 30 min (2 Hz/15 Hz，0.5－2 mA) each day for 3 days after surgery in the EA group, while the control group received basic treatment after surgery. Postoperative complications after treatment were evaluated each day. RESULTS: Following surgery, anal pain, anal pendant expansion and hematochezia were observed in both the EA group and control group. On the first day after surgery, symptom improvement was not statistically significantly different between the two groups (P>0.05)．On the 2nd and 3rd days after surgery, anal pain, anal pendant expansion and hematochezia were markedly improved in the EA group compared with those in the control group (P<0.05). CONCLUSIONS: Electroacupuncture can reduce anal pain, anal pendant expansion and hematochezia after surgery in patients with mixed hemorrhoids.

Relief effects of Compound Carraghenates Cream on edema and pain after mixed hemorrhoid surgery / 中国生化药物杂志

Objective To observe the clinical effects of compound carraghenates cream on edema and pain after mixed hemorrhoid surgery. Methods 180 cases of patients with mixed hemorrhoids divided into the observation group and the control group, 90 cases in each group according to the random number table method. The control group was treated with Vaseline oil gauze to cover wounds after operation, and the observation group was treated with compound carraghenates cream after operation. The clinical efficacy, VAS pain score , the edema symptom scores and the pain relief time, edema symptom relief time, the wound healing time ,untoward effect were compared and observed after treatment between the two groups. Results The total effective rate of treatment in the observation group was significantly higher than that in the control group (95.56％ vs 85.56％) (P<0.05). The VAS pain scores of the observation group on the 1st day, 3rd day and 7th day after treatment were significantly lower than those of the control group (P<0.05), and the edema symptom scores on the 3rd day and 7th day after treatment were significantly lower than those of the control group (P<0.05). The time for pain relief, the time for edema relief and the wound healing time in the observation group were significantly shorter than those in the control group (P<0.05). Conclusion Compound carraghenates cream can effectively relieve edema and pain after mixed hemorrhoid surgery, and it also can shorten the course of disease and promote wound healing with safety.

Comparison of curative effect between tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids for stage Ⅲ and Ⅳ hemorrhoids / 国际外科学杂志

Objective To compare the curative effect of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of patients with stage Ⅲ to Ⅳ hemorrhoids.Methods The patients with stage Ⅲ to Ⅳ hemorrhoids who underwent prolapse and hemorrhoids or tissue-selecting therapy stapler surgery in the department of General Surgery,Shanghai Ninth People's Hospital and Xinhua Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Chongming Branch,from Jan.2013 to Jun.2014 were accepted and allocated to prolapse and hemorrhoids or tissue-selecting therapy stapler group.The peri-operative parameters about operative time,blood loss,postoperative hospital stay and the time required to return to normal activity were compared by t test,The postoperative complications including pain assessment and the incidence of postoperative bleeding,urine retention,faecal urgency,fecal incontinence,anal stenosis,rectovaginal fistula and recurrence rate were compared by t test and chi-square test.Rank sum test was used to compare the recurrence rate and patient's satisfaction between the two groups.Results The operation time,intraoperative bleeding volum,postoperative hospital stay and the time required to return to normal activity in the procedure for prolapse and hemorrhoids group were signifcantly higher than those in the tissue-selecting therapy stapler group (P =0.021,P =0.003,P =0.001,P ＜0.001).The pain score of procedure for prolapse and hemorrhoids group were all higher than those of the tissue-selecting therapy stapler group in the first post-operative defecation and in post-operative 24 hours and 72 hours (all P ＜ 0.001).The incidence of faecal urgency of the procedure for prolapse and hemorrhoids group in post-operative 1 month (18.6％) was higher than that of the tissue-selecting therapy stapler group (6.6％) (P =0.036).There were no statistically significant differences in the incidence of postoperative bleeding,urinary retention,recurrence rate and patient's satisfaction between two group (P ＞ 0.05).Conclusion Tissue-selecting therapy stapler was superior to the procedure for prolapse and hemorrhoids in operation time,intraoperative blood loss,postoperative pain and the incidence of faecal urgency.Long-term results demonstrate that tissue-selecting therapy stapler and prolapse and hemorrhoids have similar effectiveness.