Circumferential Mixed Classification And Surgical Options

Object:To date, it is still unknown that the clinical morphological classification and surgical options of circumferential mixed hemorrhoid. This study was to establish the morphological classification of circular mixed hemorrhoid and assess the treatment strategies; and to provide some evidence based medicine for establishing circular mixed hemorrhoid diagnosis and treatment standards.Methods:Literatures on hemorrhoid were retrieved by searching the China Academic Journal (CNKI) database from1962to2012. Inclusion and exclusion criteria were developed. Literatures on ancient and modern classification criteria and surgical methods of hemorrhoid were collected and analyzed. Circular mixed hemorrhoid was classified with observed shape, and was provided with reasonable surgical options according to the shape of circular mixed hemorrhoid.Results:1. Type of roses:(1) The reserved area of anal canal epithelium is respectively8±0.32,4±0.45and0after PPH, milligan-morgan hemorrhoidectomy and segmented ligation. The PPH surgery reserved area is much higher than milligan-morgan hemorrhoidectomy and segmented ligation, three groups compared with significant statistical significance (P<0.05).(2)The average score of the anus flatness are respectively5.2±0.12,3±0.32and5.4±0.32after PPH, milligan-morgan hemorrhoidectomy and segmented ligation. The average score of the anus flatness after PPH surgery is much higher than milligan-morgan hemorrhoidectomy. Two groups compared with significant statistical significance (P<0.05). The average score of the anus flatness after segmented ligation is much higher than milligan-morgan hemorrhoidectomy. Two groups compared with significantly statistical significance (P<0.05). The average score of the anus flatness after PPH surgery is the same with it after segmented ligation Two groups compared no significant statistical significance(P>0.05).2. Chrysanthemum shaped:(1) The reserved area of Anal canal epithelium are respectively8±0.22,4±.55,1±0.01after PPH, milligan-morgan hemorrhoidectomy and Segmented ligation. The PPH surgery reserved area is much higher than milligan-morgan hemorrhoidectomy and segmented ligation, three groups compared with significant statistical significance (P<0.05).(2)The average score of the anus flatness are respectively5±0.35,2±0.12,1±0.02after PPH, milligan-morgan hemorrhoid-dectomy and segmented ligation. The average score of the anus flatness after milligan-morgan hemorrhoidectomy is much higher than PPH surgery. Two groups compared with significant statistical significance (P<0.05). The average score of the anus flatness after segmented ligation is much higher than PPH surgery. Two groups compared with significantly statistical significance (P<0.05). The average score of the anus flatness after milligan-morgan hemorrhoidectomy is the same with it after segmented ligation Two groups compared no significant statistical significance(P>0.05).3. Type of walnuts:(1) The reserved area of Anal canal epithelium are respectively8±0.37,6±0.26,2±0.11after PPH, milligan-morgan hemorrhoidectomy and Segmented ligation. The PPH surgery reserved area is much higher than milligan-morgan hemorrhoidectomy and segmented ligation, three groups compared with significant statistical significance (P<0.05).(2)The average score of the anus flatness are respectively1±0.12,5±0.31,5±0.12after PPH, milligan-morgan hemorrhoidectomy and segmented ligation. The average score of the anus flatness after milligan-morgan hemorrhoidectomy is much higher than PPH surgery. Two groups compared with significant statistical significance (P<0.05). The average score of the anus flatness after segmented ligation is much higher than PPH surgery. Two groups compared with significantly statistical significance (P<0.05). The average score of the anus flatness after milliganmorgan hemorrhoidectomy is the same with it after segmented ligation Two groups compared no significant statistical significance (P>0.05).4. The pig nozzle type:(1) The reserved area of Anal canal epithelium are respectively.(1) The reserved area of anal canal epithelium is respectively8±0.22,3±0.55,2±0.01after PPH, milligan-morgan hemorrhoidectomy and segmented ligation. The PPH surgery reserved area is much higher than milligan-morgan hemorrhoidectomy and segmented ligation, three groups compared with significant statistical significance (P<0.05).(2)The average score of the anus flatness are respectively1.5±0.35,1.7±0.12,5±0.02after PPH, milligan-morgan hemorrhoidectomy and segmented ligation. The average score of the anus flatness after segmented ligation is much higher than PPH surgery and milligan-morgan hemorrhoidectomy. Three groups compared with significant statistical significance (P<0.05).Conclusion:(1) PPH surgery is recommended to treated the roses circular mixed hemorrhoid. The segmented, ligation is recommended to treated the pig nozzle type circular mixed hemorrhoid.(2) Tooth ligation is appropriate for segmented ligation. milligan-morgan hemorrhoidectomy should try to keep more anal canal epithelium and methylene blue when necessary.(3) If severe circular mixed hemorrhoids cannot be completely cured by one surgery, we can use two or more surgery.