关键词: 改良, 吻合器痔上黏膜环切术, 环状混合痔, 肛门内括约肌

Abstract: Objective To explore the clinical efficacy and safety of modified PPH combined with partial internal anal sphincterotomy in the treatment of circular mixed hemorrhoids.Methods Patients with annular mixed hemorrhoids were divided into two groups by a completely randomized controlled method.54 patients in the experimental group were treated with modified PPH combined with partial internal anal sphincterotomy,while 51 patients in the control group were treated with conventional PPH.The postoperative indicators,perioperative and long-term complication rates of the two groups were compared,and the clinical efficacy and safety were observed.Results The operation time in the experimental group was (48.35±4.37) minutes,which was higher than that in the control group (36.42±6.21) minutes（P＜0.05）.The incidence of postoperative anastomotic stenosis in the experimental group was 1.9%,lower than 15.6% in the control group (P＜0.05). Anal pain,urinary retention,first defecation time,long-term anal distention,the experimental group was significantly better than the control group,the difference was statistically significant (P＜0.05); The hospitalization time in the experimental group (4.8±0.62) days was not significantly different from that in the control group (5.1±0.54) days (P>0.05).The amount of intraoperative bleeding and anastomotic bleeding in the experimental group [(17.28±2.22)ml,3.7%] were not significantly different from those in the control group [(16.75±2.13)ml,3.9%] (P>0.05).Conclusion Compared with conventional PPH,the modified PPH combined with partial internal anal sphincterotomy slightly increases the operation time,but does not increase the risk of anastomotic bleeding,the incidence of rectal fistula,the amount of surgical bleeding,and the length of hospital stay.It can significantly improve postoperative anal pain,urinary retention,long-term distention symptoms,shorten the time of first defecation,ease the difficulty of defecation,and significantly reduce postoperative anastomotic stenosis,The long-term efficacy and safety are good.

Key words: modified, proceedure for prolapse and hemorrhoids, annular mixed hemorrhoids, internal anal sphincterotomy