Abstract: Objective To explore the clinical effect of Ruiyun procedure for hemorrhoids （RPH） and procedure for prolapse and hemorrhoids （PPH） respectively combined with external stripping and internal ligation in the treatment of elderly patients with moderate to severe mixed hemorrhoids. Methods A total of 100 elderly patients who were confirmed with moderate to severe mixed hemorrhoids in the hospital from January to December 2018 were enrolled in the study. According to the random grouping method, they were divided into control group （n=50） and observation group （n=50）. The control group were treated with PPH combined with external stripping and internal ligation, while observation group were treated with RPH combined with external stripping and internal ligation. Intraoperative and postoperative related indexes in both groups were observed and recorded. The results were compared and analyzed. Results The operation time, intraoperative blood loss and hospital stay of observation group were less than those of control group （P<0.05）. The postoperative pain time and wound healing time of observation group were significantly shorter than those of control group （P<0.05）. There was no significant difference in incidence of complications between the two groups （P>0.05）. There was no significant difference in anorectal pressure between the two groups before and after operation （P>0.05）. The score of anal incontinence scale （Wexner） in observation group was significantly lower than that in control group （P<0.05）. Conclusion RPH combined with external stripping and internal ligation can shorten the operation time, reduce intraoperative blood loss, reduce the incidence of postoperative complications, and improve anal function. It is effective in the treatment of elderly patients with severe mixed hemorrhoids.

Key words: moderate to severe mixed hemorrhoid, procedure for prolapse and hemorrhoids, Ruiyun procedure for hemorrhoids, External stripping and internal ligation, elderly

摘要： 目的 探讨弹力线自动痔疮套扎术（RPH）与吻合器痔上黏膜环切术（PPH）分别联合外剥内扎术治疗中重度混合痔高龄患者的临床效果。方法 选取2018年1月~2018年12月在本院确诊为中重度混合痔的高龄患者100例,根据区组随机分组法将患者分为对照组（n=50）和观察组（n=50）,对照组行PPH联合外剥内扎术,观察组行RPH联合外剥内扎术。观察记录两组患者术中及术后相关指标,对结果进行对比分析。结果 观察组患者的手术时间短于对照组,术中出血量、住院时间低于对照组（P<0.05）;观察组患者术后疼痛时间和创面愈合时间均显著小于对照组（P<0.05）;观察组与对照组患者的并发症发生率无显著差异（P>0.05）;两组患者术前术后直肠肛管压力无显著变化,且两组间无明显差异（P>0.05）;观察组患者的肛门失禁量表（Wexner）评分显著小于对照组（P<0.05）。结论 RPH联合外剥内扎术可缩短手术时间、减少术中出血、降低术后并发症的发生率、改善肛门功能,在中重度混合痔高龄患者中疗效显著。

关键词: 弹力线自动痔疮套扎术, 外剥内扎术, 吻合器痔上黏膜环切术, 中重度混合痔, 高龄患者