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