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一项采用简化的Milligan-Morgan痔切除术行橡皮圈套扎术治疗混合痔的随机多中心临床试验

A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids.

作者信息

He Yong-Heng, Tang Zhi-Jun, Xu Xiang-Tong, Huang De-Quan, Zhang Li-Shun, Tang Qing-Zhu, Fan Zhi-Min, Zou Xian-Jun, Zou Guo-Jun, Zhang Chong-Yang, Hu Fan, Xie Biao, Li Yan-Hua, Tong Yao, Liu Hong-Chang, Li Ke, Luo Yu-Lian, Liu Fei, Situ Guang-Wei, Liu Zuo-Long

机构信息

1 The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China.

2 Changde Hospital of Hunan University of Traditional Chinese Medicine, Hunan, China.

出版信息

Surg Innov. 2017 Dec;24(6):574-581. doi: 10.1177/1553350617731205. Epub 2017 Sep 16.

Abstract

PURPOSE

To explore the safety and efficacy of Ruiyun procedure for hemorrhoids (RPH) or RPH with the simplified Milligan-Morgan hemorrhoidectomy (sMMH) in the treatment of mixed hemorrhoids.

METHODS

This is a randomized, controlled, balanced, multicenter study of 3000 patients with mixed hemorrhoids. The outcomes and postoperative complications were compared between 5 types of surgeries.

RESULTS

The efficacy rate was the highest in patients who received RPH+sMMH and decreased in the following order: patients who received RPH alone, MMH alone, procedure for prolapse and hemorrhoids (PPH) alone, and PPH+sMMH ( P < .05). The operation time was the shortest in patients who received RPH alone and increased in the following order: patients who received RPH+sMMH, PPH alone, MMH alone, and PPH+sMMH ( P < .01). The duration of postoperative hospitalization stay was the shortest in patients who received RPH alone and increased in the following order: PPH alone, RPH+sMMH, PPH+sMMH, and MMH alone ( P < .01). The incidence of postoperative hemorrhage, uroschesis, anal fissure, crissum hematoma or thrombosis, and anorectal stenosis was significantly lower in patients who received RPH+sMMH than in patients who received the other 4 types of surgical treatments ( P < .05, P < .01). No significant differences in postoperative rectovaginal fistula and anal incontinence were observed between the 5 groups of patients.

CONCLUSIONS

RPH with or without simplified MMH can reduce the incidence of postoperative complications and improve the curative efficacy in the treatment of patients with mixed hemorrhoids.

摘要

目的

探讨内痔套扎术(RPH)或RPH联合简化的Milligan-Morgan痔切除术(sMMH)治疗混合痔的安全性和有效性。

方法

这是一项针对3000例混合痔患者的随机、对照、均衡、多中心研究。比较了5种手术方式的疗效和术后并发症。

结果

接受RPH+sMMH治疗的患者有效率最高,依次降低的顺序为:单纯接受RPH治疗的患者、单纯接受MMH治疗的患者、单纯接受吻合器痔上黏膜环切术(PPH)治疗的患者、PPH+sMMH治疗的患者(P<.05)。单纯接受RPH治疗的患者手术时间最短,依次增加的顺序为:接受RPH+sMMH治疗的患者、单纯接受PPH治疗的患者、单纯接受MMH治疗的患者、PPH+sMMH治疗的患者(P<.01)。单纯接受RPH治疗的患者术后住院时间最短,依次增加的顺序为:单纯接受PPH治疗的患者、RPH+sMMH治疗的患者、PPH+sMMH治疗的患者、单纯接受MMH治疗的患者(P<.01)。接受RPH+sMMH治疗的患者术后出血、尿潴留、肛裂、肛周血肿或血栓形成以及肛门直肠狭窄的发生率明显低于接受其他4种手术治疗的患者(P<.05,P<.01)。5组患者术后直肠阴道瘘和肛门失禁的发生率无显著差异。

结论

RPH联合或不联合简化的MMH均可降低混合痔患者术后并发症的发生率,提高治疗效果。

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