| [Objective] The study aimed to analysis the relevance between the pathological damage and the clinical complicantions in PPH and Milligan-Morgan surgery. [Methods] To collect the clinical datas of patients who were operated with PPH or M-M in Nanjing Chinese Medicine Hospital, National Medical center of Anorectal disease from 2008.12 to 2010.12. Totally 58 patients,30 cases of PPH group,28 cases of M-M group, and part of them follow up 12 months. The main indexes include recurrence, the sensory function of rectum, the function of self- control in defecation, and so on. The main index of the short-term complications include pain, bleeding and bowel control. All of the surgical specimens of the cases are observed using HE and Immunohistochemistry (NSE), to see the lay of tissue they cut and count the number of microvascular density, the number of gangliocyte. Then analysis the relevance between the pathological damage and the clinical compliantions. [Results] There is statistically significant difference in organisational level, MVD and gangliocyte counting. There is positive correlation between MVD and the degree of bleeding and pain. There is negative correlation between gangliocyte counting and pain, positive correlation between gangliocyte counting and the rate of incontinence in short term. There is no correlation between organizational level and long term recurrence. But it will affect the rate of incontinence. [Conclusion] The normal tissue of intestinal wall is cut off by PPH, but in M-M group the pathological anal cushion is cut off. This may explain why the recurrence rate in PPH group is higher than that in M-M group. PPH is not a minimally invasive procedure. It easily injure the internal anal sphincter, leading anal functional damage and incontinence. The reduce of gangliocyte will lead to incontinence in short term. But there are some other reson of proctagra and incontinence in long term. |
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