[Abstract] Objective To observe the clinical effect of orthotopic skin flap grafting with tooth thread preservation in the treatment of annular mixed hemorrhoids. Methods Using a controlled study, 164 patients with circular mixed hemorrhoids were randomly divided into a treatment group of 84 cases and a control group of 80 cases. The treatment group was treated with orthotopic skin flap grafting and the control group was treated with traditional external stripping and internal ligation. To compare the healing time, pain, anal stenosis, edema and other postoperative complications and curative effects between the two groups. Results 164 patients were cured. The treatment group was better than the control group in terms of healing time, postoperative pain, anal stenosis, postoperative edema, etc. The two were statistically significant (P<0.5). Conclusion Orthotopic skin flap grafting tooth thread preservation is a safe and effective method for the treatment of circular mixed hemorrhoids.
[Key words] Orthotopic skin flap transplantation, tooth thread preservation, circular mixed hemorrhoids, Clinical study
Clinical research on 164 cases transplantation of skin flap and reserving dentate line operation in treatment for circular mixed hemorrhoids.
Liuxinghua, li jianping. Chinese medicine norectal, Hebei province Baoding Anxin County Hospital.071600
[Abstract] Objective:To evaluate the efficacy of transplantation of skin flap and reserving dentate line operation in treatment for circular mixed hemorrhoids.Methods: 164 cases of the circular mixed hemorrhoids patients were randomly devided into transplantation of skin flap and reserving dentate line operation group (n=84) and external excision and internal ligation group(n=80) to compare their cure time, pain situation, anal stricture, the swelling postoperative complications and efficacy. Results: 164 cases of patients all cured, Cure time, pain situation , anal stricture, the swelling postoperative complications in transplantation of skin flap and reserving Dentate line operation group were lower than those in external excision and internal ligation group,while curative effect is better than the control group, the difference was statistically significant (P<0.5 ). Conclusion: Transplantation of skin flap and reserving Dentate line operation is a safe and effective treatme nt for circular mixed hemorrhoids.
[Key words] transplantation of skin flap and reserving dentate line operation; circular mixed hemorrhoids; clinical research
In order to alleviate the suffering of patients, shorten the healing time of circular mixed hemorrhoids, preserve the anatomy and physiological functions of the anus to the greatest extent, and avoid postoperative complications, 164 cases of circular mixed hemorrhoids were treated with orthotopic skin flap grafting and tooth thread preservation. The clinical data of hemorrhoids are reported as follows.
1 Materials and methods
1. 1 General information: A total of 164 cases of circular mixed hemorrhoids meeting the diagnostic criteria  were admitted from 2007 to 2011. According to the order of admission, they were randomly divided into a treatment group of 84 cases and a control group of 80 cases. The treatment group: 48 males and 36 females; the oldest is 72 years old, the youngest is 18 years old, and the average age is 36 years; the longest course is 28 years, the shortest course is 3.5 years, and the average course is 8 years; control group: male 44 cases, 36 were women; the oldest was 70 years old, the youngest was 23 years old, with an average age of 41.5; the longest course was 26 years, the shortest course was 1.8 years, and the average course was 10.2 years. The two groups of patients were comparable in terms of gender, age and disease course (P>0.05).
1.2 Treatment methods: conventional preoperative preparations, intraoperative sacral anesthesia, bladder lithotomy position, disinfection, draping, and full anus expansion. Treatment group: During the operation, a fusiform incision was made at 2 and 4 points, from the distal end of the external hemorrhoids to the tooth line, and the two sides of the incision at 2 and 4 were peeled off to the opposite side, and 3 points were removed from the external hemorrhoid. From the skin bulge to the 0.5cm subcutaneous varicose veins, thrombus and connective tissue on the tooth line, the width of the normal skin flap of the external hemorrhoid should be kept between 0.3-0.5cm, and the internal hemorrhoid part should be sutured with No. 10 silk suture at 0.5cm on the tooth line After ligation, the center of the ligation is on the tooth line and the tooth line is retained. After the ligation, the skin retained by the external hemorrhoids is tightly attached to the subcutaneous tissue, the tension is moderate, and the blood supply is good. Use the same method to treat the rest of the mixture; at the 6-point incision, make a longitudinal reduction incision to cut part of the internal sphincter. Control group: A fusiform incision was made at 3 o'clock, and the venous mass, thrombus and connective tissue of the submucosal varicose skin were stripped to 0.5 cm on the tooth line, and sutured with No. 10 silk thread, trimmed the edges of both sides to make the incision Natural pair and state. Use the same method to treat the rest of the mixture; at the 6-point incision, make a longitudinal reduction incision to cut part of the internal sphincter. During the operation, the bleeding was carefully stopped. If the skin defect is too large, the suture can be interrupted. Absorbable digital hemostatic gauze is applied to the incision to stop bleeding, covered with a sterile dressing, wrapped with a tower gauze, and fixed with a "D" bandage. Antibiotics were applied for 3 days after the operation, a semi-liquid diet was given after the operation, the stool was controlled for 3 days, and the normal diet was changed after defecation. After 3 days, every day after the defecation, the traditional Chinese medicine bath was used, local disinfection, red sand strips (made by our hospital), the dressing was changed until the wound healed .
2.1 The efficacy standards and statistical methods refer to the "People’s Republic of China Traditional Chinese Medicine Industry Standards" formulated by the State Administration of Traditional Chinese Medicine in 1994 , recovery: symptoms and signs disappeared; marked effect: symptoms disappeared, leaving skin tags or internal hemorrhoid mucosa light Degree of hyperemia, hemorrhoids become smaller; effective: symptoms and signs are improved; ineffective: symptoms and signs are not improved. Observation indicators: postoperative healing time, pain, anal stenosis, edema, etc. The observation results were tested with SPSS10.0 statistical software for T test and X2 test.
2.2 Comparison of postoperative observation indexes between the treatment group and the control group. 84 patients in the treatment group and 80 patients in the control group with circular mixed hemorrhoids recovered. The average healing time of the treatment group was (11.86±1.47) days, and the control group was (13.96) ±1.97) days; T test t=3.14 for both, P=0.004<0.01; 14 cases in the treatment group of postoperative analgesics, accounting for 16.67%, 25 cases in the control group, accounting for 31.25%; postoperative edema treatment group 10 Cases, accounting for 11.9%, 18 cases in the control group, accounting for 22.5%, 3 cases in the postoperative anal stenosis treatment group, accounting for 3.75%, and 8 cases in the control group, accounting for 10%. Compared with the control group, they were statistically significant (P< 0.05). See Table 1.
Table 1 Comparison of postoperative complications in the treatment group and observation group
Treatment group Control group P value
Number of postoperative pain 14 (16.67%) 25 (31.25%) 0.028
Edema 10 (11.90%) 18 (22.5%) 0.029
Anal stenosis 3 (3.57%) 8 (10%) 0.01
Annular mixed hemorrhoids are difficult to treat in the anorectal department. It is a difficult problem faced by anorectal surgeons to remove the lesions and relieve symptoms at one time while preserving the shape and function of the anus . External stripping and internal ligation and modified surgical procedures   have good clinical effects, but there are still complications such as postoperative pain, edema, slow wound healing, sensory anal incontinence, mucosal ectropion, and anal stenosis disease. With the advancement of society, patients' requirements for treatment effects, in addition to the elimination, improvement or alleviation of symptoms, have become increasingly prominent in the pursuit of perfect appearance . On how to reduce pain, shorten the course of treatment, avoid postoperative complications, and keep the appearance of the anus smooth and beautiful, the orthotopic skin flap transplantation of internal hemorrhoids and ligament of dental floss reconstruction has achieved good clinical results in the treatment of circular mixed hemorrhoids, but banding is sometimes more effective It is difficult to grasp the position and position of the ligation, which affects the postoperative effect . Therefore, we changed the ligation to ligation to make the ligation position more accurate and easier to grasp the tension of the transplanted skin flap to make it easier to survive. In situ skin flap grafting and ligament of dental suture preservation surgery for the treatment of circular mixed hemorrhoids is designed by itself based on the theory of hemorrhoid pathogenesis and the local anatomy of the anus. Preserving the dentition means retaining the defecation reflex induction zone, completely retaining the local anatomy and physiological functions, and has little damage, does not block blood and lymph circulation, reduces the resting pressure of the anal canal, and effectively prevents postoperative edema; Keep the normal skin width of external hemorrhoids between 0.3-0.5cm and make the blood supply abundant without causing avascular necrosis of the transplanted skin flap. If it is too wide, it is easy to form local edema, and if it is too narrow, the skin flap is easy to break and dissolve necrosis. Large ulcers and scars are not easy to heal. Because the treated wound and skin flaps are in a relatively natural aligning state, the incision is relatively closed and not in contact with the outside world to reduce postoperative pain; because the varicose blood vessel mass, namely the nucleus, is more thoroughly removed, postoperative recurrence is avoided ; Due to the small range of resection and the provision of suitable flaps, the wound healed quickly and the appearance of the anus was more beautiful. The average healing time of the treatment group was only 11.86±1.47 days, while that of the control group was 13.96±1.97 days, which was significantly better In the control group (P<0.01). Because the lesion in the mother hemorrhoid area was removed, and the skin moved up after the incision was healed and ligated, the original protruding external hemorrhoids also disappeared. As a result, the anus returned to its normal anatomical shape, reduced postoperative pain, anal stenosis, postoperative edema and other complications (P<0.05) and maintained the beautiful appearance of the anus.
This research solved the problem of preserving the tooth line, ensuring the survival of the grafted skin flap, removing the lesion, preserving enough skin in the anus and having a beautiful appearance, which is in line with the concept of minimally invasive. Through the clinical study of 164 patients, we believe that orthotopic skin flap transplantation is a simple and effective method for the treatment of annular mixed hemorrhoids.
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