To compare the effects of three surgical methods on anorectal dynamics indexes, pain symptoms and postoperative complications in patients with moderate and severe mixed hemorrhoids
10.3760/cma.j.cn115455-20230907-00219
- VernacularTitle:比较三种手术方式治疗对中重度混合痔患者肛肠动力学指标、疼痛症状及术后并发症的影响
- Author:
Jun GE
1
;
Sheng XU
1
;
Lingling ZHANG
1
Author Information
1. 铜陵市人民医院肛肠科，铜陵 244000
- Publication Type:Journal Article
- Keywords:
Hemorrhoids;
Partial resection of rectal mucosa;
Haemorrhoidectomy;
Partial internal anal sphincterotomy;
Anorectal dynamics
- From:
Chinese Journal of Postgraduates of Medicine
2025;48(4):326-331
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of three surgical methods on anorectal dynamics indexes, pain symptoms and postoperative complications in patients with moderate to severe mixed hemorrhoids.Methods:Eighty patients with moderate to severe mixed hemorrhoids diagnosed and treated in Tongling People′s Hospital from March 2021 to December 2022 were retrospectively selected as the study objects, and they were divided into mucosal resection group (30 cases), sphincterotomy group (30 cases) and mixed hemorrhoidal resection group (20 cases) according to the treatment methods. The basic conditions of operation, anorectal dynamics indexes, pain symptoms and postoperative complications were compared among the three groups.Results:The operative time, intraoperative blood loss, first postoperative defecation time, postoperative bed time and hospital stay in the mucosa resection group were all shorter than those in the sphincterotomy group and the mixed hemorrhoidectomy group:(20.57 ± 5.85) min vs. (24.68 ± 4.66) and (33.86 ± 4.27) min, (4.19 ± 0.54) ml vs. (6.34 ± 0.82) and (9.25 ± 1.39) ml, (1.57 ± 0.12) d vs. (1.95 ± 0.32) and (2.48 ± 0.54) d, (1.43 ± 0.35) d vs. (1.64 ± 0.41) and (1.90 ± 0.44) d, (4.57 ± 0.39) d vs. (5.83 ± 0.47) and (7.64 ± 0.55) d, there were statistical differences ( P<0.05). The above indexes in the sphincterectomy group were shorter than those in the mixed hemorrhoidectomy group, there were statistical differences ( P<0.05). The maximum rectal volume threshold (RMTV), rectal perception threshold (RSTV) and maximum rectal systolic blood pressure (MASP) in the resection group were higher than those in the sphincterotomy group: (201.59 ± 40.13) ml vs. (178.45 ± 38.59) ml, (65.54 ± 18.29) ml vs. (54.62 ± 20.39) ml, (126.36 ± 12.29) mmHg (1 mmHg = 0.133 kPa) vs. (42.23 ± 14.46) mmHg, anal canal resting pressure (RASP) was lower than that in the sphincterotomy group: (32.59 ± 10.25) mmHg vs. (63.50 ± 13.69) mmHg, there were statistical differences ( P<0.05). The RMTV and RSTV in the sphincterotomy group were higher than those in the mixed hemorrhoidectomy group: (178.45 ± 38.59) ml vs. (135.85 ± 35.68) ml, (54.62 ± 20.39) ml vs. (41.34 ± 20.55) ml, the RASP and MASP were lower than those in the mixed hemorrhoidectomy group :(63.50 ± 13.69) mmHg vs. (73.33 ± 15.69) mmHg, (42.23 ± 14.46) mmHg vs. (128.66 ± 16.33) mmHg, there were statistical differences ( P<0.05). The postoperative visual analogue scale (VAS) score in the mucosa resection group were lower than those in the sphincterotomy group and the mixed hemorrhoidectomy group: (1.57 ± 0.25) score vs. (2.57 ± 0.36) and (3.42 ± 0.52) score, there were statistical differences ( P<0.05). The VAS scores in the sphincterectomy group was lower than that in the mixed hemorrhoidectomy group, there was statistical difference ( P<0.05). The incidence of postoperative complications in the mucosa resection group was lower than that in the sphincterectomy group: 3.33% (1/30) vs. 20.00% (6/30), and the incidence of postoperative complications in the sphincterectomy group was lower than that in the mixed hemorrhoidectomy group: 20.00% (6/30) vs. 50.00% (10/20), there were statistical differences ( χ2 = 4.04, 4.96, P<0.05). Conclusions:Compared with partial internal anal sphincterotomy and external stripping and internal ligation of mixed hemorrhoids, partial rectal mucosal resection is more effective in the treatment of Ⅲ~Ⅳ grade mixed hemorrhoids, which can effectively restore anorectal dynamic indexes, reduce postoperative pain and reduce the occurrence of complications.
