Cheetham M J, Mortensen N J, Nystrom P O, Kamm M A, Phillips R K
Department of Surgery, St Mark's Hospital, Harrow, Middlesex, UK.
Lancet. 2000 Aug 26;356(9231):730-3. doi: 10.1016/S0140-6736(00)02632-5.
Haemorrhoidectomy usually cures haemorrhoids. Day surgery is feasible, and is associated with high patients' satisfaction and few complications, but patients take an average of 2 weeks off work after surgery. Stapled haemorrhoidectomy has the potential to decrease postoperative pain and time off work. However, data on long-term efficacy and function are lacking.
22 patients underwent stapled haemorrhoidectomy: seven in a pilot study, and 15 in a randomised controlled trial to compare the new stapled operation with diathermy haemorrhoidectomy in a day-case setting. All operations were done by one consultant surgeon.
16 patients were followed up for longer than 6 months, five of whom (31% [95% CI 8.5-54.0%]) developed symptoms of pain and faecal urgency which persisted for up to 15 months postoperatively. The randomised trial was suspended, and patients were investigated with endoanal ultrasonography, anorectal physiology, and examination under anaesthetic. All five affected patients were reviewed by two independent surgeons experienced in the stapled operation. In one patient, a fibroepithelial polyp was found adjacent to an anodermal ulcer; in the other patients, no abnormality was found. Four of the five affected patients had some muscle incorporated into the doughnut, compared with only one of 11 of the unaffected patients (p=0.012, Fisher's exact test). No other significant differences in operative variables were identified between patients with and without symptoms.
Persistent severe pain and faecal urgency has been found in a disturbingly high proportion of patients after stapled haemorrhoidectomy. The mechanism behind this phenomenon is unclear, although muscle incorporation in the doughnut may have a role. Other groups who have studied stapled haemorrhoidectomy urgently need to audit their long-term results to assess the frequency of this problem.
痔切除术通常可治愈痔疮。日间手术是可行的，患者满意度高且并发症少，但患者术后平均需休假2周。吻合器痔上黏膜环切术有可能减轻术后疼痛并缩短休假时间。然而，缺乏关于其长期疗效和功能的数据。
22例患者接受了吻合器痔上黏膜环切术，其中7例参与一项初步研究，15例参与一项随机对照试验，在日间手术环境下将这种新的吻合器手术与电凝痔切除术进行比较。所有手术均由一名顾问外科医生完成。
16例患者接受了超过6个月的随访，其中5例（31%[95%可信区间8.5 - 54.0%]）出现疼痛和排便急迫症状，这些症状在术后持续长达15个月。随机对照试验暂停，对患者进行了肛管超声检查、肛肠生理学检查及麻醉下检查。所有5例受影响患者均由两名有吻合器手术经验的独立外科医生进行评估。1例患者在肛门皮缘溃疡附近发现一个纤维上皮息肉；其他患者未发现异常。5例受影响患者中有4例的黏膜环中包含一些肌肉组织，而11例未受影响患者中只有1例如此（P = 0.012，Fisher精确检验）。有症状和无症状患者之间在手术变量方面未发现其他显著差异。
吻合器痔上黏膜环切术后，相当高比例的患者出现了持续的严重疼痛和排便急迫症状，令人不安。尽管黏膜环中包含肌肉组织可能起了一定作用，但这一现象背后的机制尚不清楚。其他研究吻合器痔上黏膜环切术的团队迫切需要审核其长期结果，以评估该问题的发生率。
