Clinical Study Of Modified PPH With Single Purse Four-point Traction In The Treatment Of Mixed Hemorrhoids Of Grade ?-?

Objectives:To compare the clinical effects of modified PPH with single purse string and four-point traction and conventional PPH in the treatment of mixed hemorrhoids of grade ?-?,and to evaluate the clinical efficacy of modified PPH in order to provide better treatment techniques to promote the recovery and prognosis of patients and improve the therapeutic effect.Methods:From December 2016 to February 2019,140 patients with mixed hemorrhoids of grade III-IV were were selected and randomly divided into two groups: modified PPH group(n = 70)were treated with modified PPH with single purse string and four-point traction and conventional group(n = 70)were treated with conventional single purse string and single-point traction PPH.All patients met the inclusion criteria without excluding cases.The clinical data of modified PPH group and conventional PPH group were compared,including:(1)General data: sex,age,course of disease,hemorrhoid stage and preoperative symptoms,(2)comparison of clinical efficacy;(3)comparison of intraoperative conditions: intraoperative bleeding,operation time,width and uniformity of resected mucosal ring,degree of hemorrhoid nucleus retraction.(4)comparison of postoperative recovery: postoperative complications(bleeding,anal stricture,anal distension,etc.),pain on the first day,the third day 3rd and the seventh day,day 3 and day 7 after surgery(VAS score),hospital stay and postoperative recurrence,The patients were followed up for 1 year by outpatient or telephone after operation.Result:There was no significant difference in sex,age,course of disease,stage of hemorrhoids and preoperative symptoms between the modified PPH group and the traditional PPH group(P > 0.05).The treatment of two groups was effective.However,The modified PPH group that the cure rate was higher than that the conventional PPH Group [95.71% vs 82.86%,?~2= 6.048,P = 0.014],the difference was statistically significant.In the modified PPH group,the width of resected mucosal rings [(3.62+0.65)cm vs(2.33+0.54)cm,82.86%,t = 12.772,P < 0.001],the uniformity of mucosal rings [66 cases(94.29%)vs 55 cases(78.57%),?~2 = 7.368,P = 0.007],and the complete retraction of hemorrhoids [67 cases(95.71%)vs 58 cases(82.86%),2 = 6.048,P = 0.014] were due to PPH conventional group.Two group in operation time and bleeding was no significant difference(P > 0.05).It is no no significant difference that pain score on the first day [ 3.18±2.74 vs 3.56±3.38,P=0.466],the third day 3rd [ 2.39±1.58 vs 2.68±1.65,P=0.290] and on the seventh day [ 1.01±0.9 vs 1.23±1.11,P=0.216] after operation,complications such as bleeding,anal swelling,anal stenosis and hospitalization time between the two groups(P > 0.05).The overall incidence of complications in the modified PPH group was less than that in the conventional PPH Group [8 cases(8.57%)vs 14 cases(20.00%),?~2 = 3.773,P = 0.053],but there was no significant difference between the two groups.After 1 year follow-up,the recurrence rate in the modified PPH group was lower than that in the conventional PPH Group [0 case(0%)vs 5 case(7.14%),? 2 = 5.18,P = 0.022].Conclusion:1.Modified PPH with single purse purse string and four-point traction is easy to apply and master.The main reason lies in the uniform force exerted on the purse line.The function of four traction forces is easier to realize this technique and obtain satisfactory mucosal rings.2.Modified PPH with single purse string and four-point traction is suitable for patients with mixed hemorrhoids of grade III-IV.The resected mucosa is wide and complete,which makes the anal cushion lifted and fixed and the hemorrhoid nucleus retracted completely.The incidence of postoperative complications is relatively reduced,and the effective retraction of hemorrhoid nucleus reduces the recurrence rate.The therapeutic effect and prognosis have obvious advantages.