Ultrasound Knife External Malleolus Resection Combined With Elastic Line Internal Ligation For The Treatment Of III And IV Mixed Hemorrhoids

Background:Hemorrhoids is one of the most common anorectal diseases,Its symptoms include hematochezia,prolapse,pain accompanied by anus bulge,itching and etc.When the symptoms developd into ?,?-degree mixed hemorrhoids,surgical treatment should be carried out.So far,surgical treatment methods for ?,?-degree of mixed hemorrhoid are mainly Milligan-Morgan hemorrhodectomy and its various modified surgeries,procedure for prolapse and hemorrhoids,tissue-selecting therapy or the operation of the combined above-mentioned ways.However,these surgical procedures have some limitations.Professor Li Huashan founded a new surgical procedure integrated with the concept of minimally invasive surgery and his rich clinical experience.Harmonic scalpel combined with elastic line ligation device for the treatment of mixed hemorrhoids is designed to provide theoretical basis for broad clinical application and new ideas for minimally invasive surgery.Objective:To preliminarily evaluate the advantages of new surgical procedure by observing the clinical efficacy of the treatment of III,IV-degree mixed hemorrhoids with external hemorrhoidectomy of harmonic scalpelcombined with elastic line ligation for internal hemorrhoids,and to provide theoretical basis for clinical promotion of the combination of external hemorrhoidectomy of harmonic scalpelwith elastic line ligation for internal hemorrhoids for the treatment III,IV-degree mixed hemorrhoids.Methods:A randomized,parallel controlled principle was used.A total of 64 cases of patients with ?,?-degree mixed hemorrhoids in Guang'anmen Hospital from Jun.1,2016 to Dec.31,2016 were divided into new procedure group and traditional procedure group with 32 patients in each group.Patients in the new procedure group was treated with external hemorrhoidectomy of harmonic scalpel combined with elastic line ligation for internal hemorrhoids,while the traditional procedure group was given Milligan-Morgan hemorrhodectomy.The differences in operation time,intraoperative blood loss,postoperative pain score,edema score,other postoperative complications,wound healing time,hospitalization cost,recurrence rate and patient satisfaction were compared between the two groups.Adverse reactions were recorded in detail.The two groups were followed up for 3 months.All data were analyzed by spss20.0,using bilateral test,P<0.05 meaning the significant difference,P<0.01 indicating very significant difference.T test or nonparametric rank sum test was chosen as measurement data and ranked data.Four grid table chi-square test and chi-square test of contingency table data were used for the count data.Results:1.Comparison of efficacy evaluation:There are 32 cases of patients in the new procedure group,and there are 31 cured cases in the traditional procedure group,1 improved case,.with 100%total effective rate.Compared the new procedure with the control group,the total effective rate was not statistically significant(P>0.05).2.Comparison of intraoperative conditions:compared the new procedure group with the traditional procedure group,the operation time and intraoperative blood loss of the new procedure group were significantly less than that of the traditional procedure group,and the difference were statistically significant(P<0.01).3.Comparison of postoperative conditions:(1)Compared the new procedure group with the traditional procedure group,the difference in the time of the first discharge of stool time after operation was not statistically significant(P>0.05);(2)In the new procedure group,the level of pain of the first stool-discharging and during the first and seventh day after operation was significantly lower than that of the traditional procedure group,the differences were significant(P<0.01);The difference had no significant difference after the 14th day of operation between the two groups(P>0.05).(3)The difference of duration of anal edema,duration of wound healing and hospital stays were statistically significant(P<0.01).The difference of duration of anal swelling had statistical significance(P<0.05)and the new procedure group is superior to the traditional procedure group.But the two groups had no significant difference in postoperative bleeding,hemorrhoid prolapse,anal edema score,anal bulge rate,urination,anal stenosis and anal incontinence(P>0.05).(4)The hospitalization expenses of the new procedure group was higher than that of the traditional procedure group,they had significantly different(P<0.01).(5)Comparison of the follow-ups:The degree of patients' satisfaction of the new procedure group was higher than that of the traditional procedure group,the difference was significant(P<0.01).Compared the new procedure group with the traditional procedure group,the relapse rate had no significant difference(P>0.05).Conclusion:Compared with the traditional methods of Milligan-Morgan hemorrhodectomy,external hemorrhoidectomy of harmonic scalpel combined with elastic line ligation for internal hemorrhoids,not only protects the function of the anus with hardly damaging the anal canal and anal pad tissue,but also shortens the operation time and reduces the amount of intraoperative blood loss with less postoperative complications and high degree of patients.Namely,it is safe,effective with less pain,fast recovery and other advantages,and it provides a new idea for the minimally invasive surgery and is worthy of clinical application and promotion.