Effect of mixed hemorrhoid after tissue-selecting therapy stapler combined with Milligan-Morgan hemorrhoidectomy on recovery and recurrence of anorectal motility in mixed hemorrhoid patients

doi:10.3877/cma.j.issn.1674-0793.2018.03.009

Abstract

Abstract:

Objective

To investigate the curative effect of tissue-selecting therapy stapler (TST) combined with Milligan-Morgan hemorrhoidectomy in mixed hemorrhoids patients, and the influences on anorectal motility recovery and recurrence.

Methods

From December 2014 to December 2016, sixty-five cases of mixed hemorrhoids diagnosed by People’s Hospital of Taishan District were selected. According to the treatment methods, they were divided into control group (33 cases, underwent Milligan-Morgan hemorrhoidectomy) and combined group (32 cases, underwent Milligan-Morgan hemorrhoidectomy+TST). The anorectal motility levels, including length of high pressure zone (HPZ), anal anal resting pressure (ARP), maximums systolic pressure (MSP), were measured at preoperation and 6 months after the operation. The curative effect, complications and recurrence between the two groups were statistically analyzed after 6 months of follow-up.

Results

There was no surgical failure in the two groups. Operation time of the control group was significantly less than that of the combined group, the intraoperative bleeding of the control group was significantly higher than that in the combined group, with statistically significant differences (t=5.627, 14.939, both P<0.001). The effective rates of the combined group and the control group were 93.75% (30/32), 87.88% (29/33), respectively, and the difference was not statistically significant (χ²=1.513, P=0.469). There was no significant difference in anorectal motility between the two groups before operation. But after 6 months, the levels of HPZ, ARP and MSP in the combined group were significantly higher than those in the control group (χ²=5.791, 5.120, 4.978, all P<0.01). And 6 months after operation, the complication rate and recurrence rate in the combined group were significantly lower (χ²=4.447, 5.107, P=0.035, 0.024).

Conclusions

Compared with Milligan-Morgan hemorrhoidectomy, TST combined with Milligan-Morgan hemorrhoidectomy is curative for the mixed hemorrhoids patients. It can effectively reduce the incidence of complications, prevent recurrence, is good for anorectal dynamic recovery, and worthy of further promotion in clinical practice.

Key words: Hemorrhoids, Tissue-selecting therapy stapler, Milligan-Morgan hemorrhoidectomy, Anorectal motility, Recurrence

Wei Liu. Effect of mixed hemorrhoid after tissue-selecting therapy stapler combined with Milligan-Morgan hemorrhoidectomy on recovery and recurrence of anorectal motility in mixed hemorrhoid patients[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(03): 188-191.

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References 18

[1]	Seheyer M, Antonietti E, Rollinger G, et al. Hemorrhoidal artery ligation (HAL) and rectoanal repair(RAR) : retrospective analysis of 408 patients in a single center[J]. Teeh Coolproctol, 2015, 19(1): 5.
[2]	王环，丁永红，张丽. RPH配合传统外剥内扎法治疗混合痔患者的临床效果观察[J]. 中国社区医师, 2016, 32(22): 64-65.
[3]	戢敏，杜勇军，陈敏, 等. TST术治疗混合痔的临床疗效观察[J]. 重庆医学, 2013, 42(8): 942-943.
[4]	美国结直肠外科医师协会标准化工作委员会. 痔诊断和治疗指南（2010修订版）[J]. 中华消化外科杂志, 2012, 11(3): 243-247.
[5]	陈二林，樊勇. 吻合器痔上黏膜环切钉合术治疗混合痔206例[J/CD]. 中华普通外科学文献（电子版）, 2017, 11(5): 346-348.
[6]	Huang HX, Yao YB, Tang Y. Application of 'tying, binding and fixing operation’ in surgical treatment of severe mixed hemorrhoids[J]. Exp Ther Med, 2016, 12(2): 1022-1028.
[7]	张曦文. 选择性痔上黏膜吻合术与吻合器痔上黏膜环切术治疗混合痔的疗效比较[J]. 医学临床研究, 2015, 32(8): 1579-1581.
[8]	Tanaka S, Toyonaga T, Morita Y, et al. Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids[J]. World J Gastroenterol, 2016, 22(27): 6268-6275.
[9]	夏羽齐. 不同术式治疗混合痔术后肛门动力学改变情况比较[J]. 齐齐哈尔医学院学报, 2015, 36(30): 4554-4556.
[10]	Lu M, Shi GY, Wang GQ, et al. Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids[J]. World J Gastroenterol, 2013, 19(30): 5011-5015.
[11]	王启，陈会林，刘铫, 等. 选择性痔上黏膜切除术治疗混合痔60例[J]. 中国中西医结合外科杂志, 2015, 21(1): 54-56.
[12]	Lu M, Yang B, Liu Y, et al. Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation[J]. World J Gastroenterol, 2015, 21(26): 8178-8183.
[13]	戢敏，杜勇军，唐太春, 等. TST联合外剥内扎术治疗混合痔的临床观察[J]. 实用中西医结合临床, 2013, 13(3): 10-12.
[14]	张全辉，邓永文，姚玉乔. 改良TST术治疗Ⅲ-Ⅳ度混合痔59例的疗效[J]. 实用临床医学, 2016, 17(7): 53-54, 56.
[15]	Wang ZG, Zhang Y, Zeng XD, et al. Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy[J]. World J Gastroenterol, 2015, 21(8): 2490-2496.
[16]	王钟焰，杨瑞琦，刘一迪, 等. 比较混合痔TST术与PPH术对肛肠动力学影响及临床意义[J]. 中国农村卫生, 2015, 8(3): 56-57.
[17]	唐力，霍斌，王家凯. 加强荷包缝合TST术与PPH术联合外剥内扎治疗重度混合痔的疗效对比[J]. 世界中医药, 2016, 11(B06): 1712-1713.
[18]	杨向东，余腾江，理习阳, 等. TST联合外剥内扎术预防环状混合痔术后肛缘水肿的临床观察（附100例报告）[J]. 结直肠肛门外科, 2013, 19(1): 36-38.

组别	例数	性别(男/女,例)	年龄(岁, ±s)	体质量指数(kg/m², ±s)	病程(年, ±s)	内痔分度(例)		合并疾病(例)
组别	例数	性别(男/女,例)	年龄(岁, ±s)	体质量指数(kg/m², ±s)	病程(年, ±s)	Ⅲ	Ⅳ	直肠息肉	直肠前突
对照组	33	12/21	25~68(48.39±11.31)	19.43~30.48(25.57±4.21)	1~18(9.67±3.43)	28	5	16	20
联合组	32	10/22	25~69(48.58±11.34)	19.29~30.62(25.63±4.28)	1~19(9.82±3.48)	25	7	18	22
统计值		χ²=0.190	t=0.068	t=0.057	t=0.175	χ²=0.488		χ²=0.002
P值		0.663	0.946	>0.05	>0.05	0.485		0.961

组别	例数	性别(男/女,例)	年龄(岁, ±s)	体质量指数(kg/m², ±s)	病程(年, ±s)	内痔分度(例)		合并疾病(例)
组别	例数	性别(男/女,例)	年龄(岁, ±s)	体质量指数(kg/m², ±s)	病程(年, ±s)	Ⅲ	Ⅳ	直肠息肉	直肠前突
对照组	33	12/21	25~68(48.39±11.31)	19.43~30.48(25.57±4.21)	1~18(9.67±3.43)	28	5	16	20
联合组	32	10/22	25~69(48.58±11.34)	19.29~30.62(25.63±4.28)	1~19(9.82±3.48)	25	7	18	22
统计值		χ²=0.190	t=0.068	t=0.057	t=0.175	χ²=0.488		χ²=0.002
P值		0.663	0.946	>0.05	>0.05	0.485		0.961

组别	例数	HPZ(cm)		ARP(mmHg)		MSP(mmHg)
组别	例数	术前	术后6个月	术前	术后6个月	术前	术后6个月
对照组	33	3.26±0.35	3.68±0.38	29.62±3.21	39.92±4.12	103.45±11.27	116.45±12.82
联合组	32	3.21±0.33	4.27±0.44	30.02±3.39	45.21±4.21	102.04±11.11	133.36±14.54
t值		0.592	5.791	0.489	5.120	0.508	4.978
P值		3.931	<0.001	4.907	<0.001	4.676	<0.001

组别	例数	HPZ(cm)		ARP(mmHg)		MSP(mmHg)
组别	例数	术前	术后6个月	术前	术后6个月	术前	术后6个月
对照组	33	3.26±0.35	3.68±0.38	29.62±3.21	39.92±4.12	103.45±11.27	116.45±12.82
联合组	32	3.21±0.33	4.27±0.44	30.02±3.39	45.21±4.21	102.04±11.11	133.36±14.54
t值		0.592	5.791	0.489	5.120	0.508	4.978
P值		3.931	<0.001	4.907	<0.001	4.676	<0.001

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