A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids

作者:He, Yong-heng*; Tang, Zhi-jun; Xu, Xiang-tong; Huang, De-quan; Zhang, Li-shun; Tang, Qing-zhu; Fan, Zhi-min; Zou, Xian-jun; Zou, Guo-jun; Zhang, Chong-yang; Hu, Fan; Xie, Biao; Li, Yan-hua; Tong, Yao; Liu, Hong-chang; Li, Ke; Luo, Yu-lian; Liu, Fei; Situ, Guang-wei; Liu, Zuo-long
来源:Surgical Innovation, 2017, 24(6): 574-581.
DOI:10.1177/1553350617731205

摘要

Purpose. To explore the safety and efficacy of Ruiyun procedure for hemorrhoids (RPH) or RPH with the simplified Milligan-Morgan hemorrhoidectomy (sMMH) in the treatment of mixed hemorrhoids. Methods. This is a randomized, controlled, balanced, multicenter study of 3000 patients with mixed hemorrhoids. The outcomes and postoperative complications were compared between 5 types of surgeries. Results. The efficacy rate was the highest in patients who received RPH+sMMH and decreased in the following order: patients who received RPH alone, MMH alone, procedure for prolapse and hemorrhoids (PPH) alone, and PPH+sMMH (P < .05). The operation time was the shortest in patients who received RPH alone and increased in the following order: patients who received RPH+sMMH, PPH alone, MMH alone, and PPH+sMMH (P < .01). The duration of postoperative hospitalization stay was the shortest in patients who received RPH alone and increased in the following order: PPH alone, RPH+sMMH, PPH+sMMH, and MMH alone (P < .01). The incidence of postoperative hemorrhage, uroschesis, anal fissure, crissum hematoma or thrombosis, and anorectal stenosis was significantly lower in patients who received RPH+sMMH than in patients who received the other 4 types of surgical treatments (P < .05, P < .01). No significant differences in postoperative rectovaginal fistula and anal incontinence were observed between the 5 groups of patients. Conclusions. RPH with or without simplified MMH can reduce the incidence of postoperative complications and improve the curative efficacy in the treatment of patients with mixed hemorrhoids.