| Background:Hemorrhoids are a class of surgical diseases which extremely often occures in anal. Domestic survey data showes that people may suffer the disease almost at any age. Hemorrhoids can be induced by a variety of reasons, such as excessive fatigue, chronic constipation, bad habbits of diet and so on. Prolapsed hemorrhoids is one of the most common species, and the degree of III, IV is very common in recent years.what’s worse, its incidence has increased year by year. Surgery is the key method to completely cured III, IV degree prolapsed hemorrhoids, for the reason that conservative treatment without surgery is commonly very difficult to cure it. So what the disease brings to people is only inconvenience and pain. Since the ancient times, there are a wide range of hemorrhoid surgical method. However, we can divide them into two types according to the instruction theory:hemorrhoids resection and preservation of anal cushion operation. The basic principles of hemorrhoids resection is to remove or destroy the hemorrhoidal tissue, which wound is large comparatively, and often accompanied by severe pain, bleeding, delayed healing. Severe conditions incould that excessive destruction of anal tissue or excessive hyperplasia of the wound scar tissue can lead to anal stenosis, deformity anus, anal leakage and other adverse conditions. In recent 10 years, with the anal cushion theory down gradually get access to the industry recognition, as well as innovation and minimally invasive surgical hemorrhoid concept and application of minimally invasive techniques, hemorrhoid has become a hot topic of enduring. Procedure for Prolapse and Hemorrhoids (PPH) and Tissue Selective Therapy (TST) are the representives for the minimally invasive surger of III, IV degree prolapsed hemorrhoids, but both of them have their disadvantages. Therefore, how to reduce the injury to anus and how to obtain good results of operations is still a dilemma to be solved.Objective:This topic searched a lot of clinical data and literature, summarized and outlines the classic PPH surgical and TST surgical’s advantages and disadvantages. We combined the improved TST surgical with sclerotherapy according to modern medicine minimally invasive principles, to treat III, IV degree prolapsed hemorrhoids, so that the two procedures complement each other’s strengths and weaknesses, and thus to explore a new coperative methods to cure III, IV degree prolapsed hemorrhoids, which has a better curative effect, a low rate of relapse, fewer complications.The main objective:To compare the efficacy and recurrence between the improved TST combined with sclerotherapy and the improved TST on the treatment of hemorrhoids (followed up for 6 months).Secondary objectives:To compare the security (intraoperative and postoperative bleeding, urinary retention, anal stenosis, anal leakage and other leakage incidence of adverse events), surgery after the extent and duration of anal pain, wound healing time, total hospital costs and patient satisfaction between the improved TST combined with sclerotherapy and the improved TST on the treatment of hemorrhoids.Methods:According to the inclusion criteria listed in this paper, selecting 30 patients who got the III or IV degree prolapsed hemorrhoids, then divide them into two groups randomly: experimental group (15 patients) and control group (15 patients). The experimental group adopt "the improved TST combined with sclerotherapy"; while the control group surgical adopt "improved TST surgery."Results:Before treatment, there was no significant difference between the treatment group and the control group in the age, sexuality, course of disease and so on. After the surgery, the outcome is as follows:①The cure rate of the two groups of patients were all 100%. ②The urinary retention of the two groups are equal to each other, and therefore we can’t be considered statistically different from the value of the two groups in terms of postoperative urinary both sides (P>0.05).③Both the intraoperative bleeding and the postoperative bleeding of experimental group are less than control group, and the difference statistically significant (P<0.05).④The difference of postoperative pain was statistically significant between the two groups on the 3rd day postoperatively (P<0.05), so parents of test group suffered less pain.⑤ The difference between the 2 groups in terms of anxious sense on the 3rd day after operation is statistically significant. (P>0.05).⑥One month after anal surgery, the difference between the experimental and control groups was not statistically value in the rate of anal stenosis (P>0.05). ⑦It’s easy to conclude that there is no significant difference in the anal function between two groups both before and after surgery (P>0.05). Similarly, when it comes to the difference of the anal function before and after the surgery, neither the treatment group nor the control group have no significant difference while P>0.05.⑧The average healing time of test group was 17.33±2.38 days while the control group was 22.60±3.66. Because P<0.05, the difference of the two groups was obvious.⑨Hospital costs and patient satisfaction:The average cost of the experimental group was 15.8±2.3 thousand Yuan; while the control group cost was 16.4±2.2 thousand Yuan, so the two surgery program costs considerably (P>0.05). In the question of patient satisfaction, there is still no evidence to show the significant difference (P>0.05). ⑩After a six-month follow-up, we considered that the difference between the two groups on the question of recurrence rate is negative (P>0.05).Conclusion:All patients in the experimental group and the control group were cured in a short time, the cure rate of the two groups was up to 100%, but the experimental group’s advantages can be reflected in the intraoperative and postoperative bleeding, anal pain, wound healing time. It’s believed that without affecting the efficacy or increasing other complications, this project can alleviate the suffering of patients, shorten the course of disease, in line with the concept of contemporary minimally invasive treatment of hemorrhoids. The procedure is a new way to treat hemorrhoids which has a better efficacy, fewer complications, less pain, short healing time. We believe that this new method is worthy of clinical application. |
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