Keighley M R, Buchmann P, Minervini S, Arabi Y, Alexander-Williams J
Br Med J. 1979 Oct 20;2(6196):967-9. doi: 10.1136/bmj.2.6196.967.
Two hundred and sixteen consecutive patients seen for the first time with symptomatic haemorrhoids entered trials of conservative and minor surgical treatment. They were divided into two groups according to their pretreatment maximal anal pressure. Patients with pressures of 100 cm H2O (73.7 mm Hg) or more (108 patients) were treated by anal dilatation (37), sphincterotomy (34), or high-fibre diet (37). Four and 12 months later anal dilatation had produced significantly better results than sphincterotomy or diet. Furthermore, anal dilatation was the only treatment associated with a significant reduction in anal pressure at four and 12 months. Patients with pressures under 100 cm H2O (108 patients) were treated by rubber-band ligation (35), cryosurgery (36), or diet (37). Four and 12 months later significantly more patients were improved by rubber-band ligation than by cryosurgery or diet. These results suggest that haemorrhoids in patients with excessive activity of the internal anal sphincter are best treated by anal dilatation and that in all other patients rubber-band ligation is the treatment of choice.
216例首次因症状性痔前来就诊的患者进入了保守治疗和小型手术治疗的试验。根据治疗前最大肛管压力将他们分为两组。压力为100 cm H₂O（73.7 mmHg）或更高的患者（108例）接受扩肛治疗（37例）、括约肌切开术（34例）或高纤维饮食治疗（37例）。4个月和12个月后，扩肛治疗的效果明显优于括约肌切开术或饮食治疗。此外，扩肛是唯一在4个月和12个月时与肛管压力显著降低相关的治疗方法。压力低于100 cm H₂O的患者（108例）接受橡皮圈套扎术（35例）、冷冻手术（36例）或饮食治疗（37例）。4个月和12个月后，接受橡皮圈套扎术改善的患者明显多于接受冷冻手术或饮食治疗的患者。这些结果表明，肛管内括约肌活动过度的患者的痔最好采用扩肛治疗，而在所有其他患者中，橡皮圈套扎术是首选的治疗方法。
