Schmidt M P, Fischbein J, Shatavi H
Koloproktologie, Katholische Kliniken, Marienhospital Altenessen, Essen.
Zentralbl Chir. 2002 Jan;127(1):15-8. doi: 10.1055/s-2002-20226.
Stapled Hemorrhoidectomy is when correctly indicated an easy feasible operative procedure for prolapsing internal hemorrhoids with or without a mucosal prolapse offering benefits to the patient. From July 1998 to October 2000 we treated 152 patients with a mean age of 52 (24-91) years for hemorrhoids within this study. We compared 72 patients, treated with stapled hemorrhoidectomy according to Koblandin-Longo with 80 patients who underwent a "conventional" reconstructive operation (Parks or Fansler-Arnold). All resected material was histopathologically examined. With stapler hemorrhoidectomy we found on average shorter operation times (22 vs. 53 min, p < 0.01), shorter hospitalisation (3 vs. 6.1 d, p < 0.01), significantly less postoperative pain (VAS 0-10: 1.83 vs. 3.70, p < 0.01) and fewer cumulative requests for analgesia by the patients (0.92 vs. 3.11 single doses, p < 0.01). The complication rate was 4 % in the stapler group and 11 % in the conventional group. Stapled hemorrhoidectomy was carried out only in patients with 3 degrees hemorrhoids with or without mucosal prolapse. The conventional group consisted of patients with 3 degrees prolapsing or 4 degrees fixated external hemorrhoids. Although very promising results are actually described with stapler hemorrhoidectomy, the established conventional reconstructive operations should be continued until long-term results are published.
吻合器痔切除术在正确应用时,对于伴有或不伴有黏膜脱垂的内痔脱垂患者而言,是一种简单可行的手术方法,能给患者带来益处。在本研究中,从1998年7月至2000年10月,我们治疗了152例平均年龄为52岁(24 - 91岁)的痔疮患者。我们将72例根据Koblandin - Longo法接受吻合器痔切除术的患者与80例接受“传统”重建手术(Parks术或Fansler - Arnold术)的患者进行了比较。所有切除的组织均进行了组织病理学检查。采用吻合器痔切除术时,我们发现平均手术时间更短(22分钟对53分钟,p < 0.01),住院时间更短(3天对6.1天,p < 0.01),术后疼痛明显减轻(视觉模拟评分法0 - 10分:1.83对3.70,p < 0.01),患者累积镇痛需求更少(0.92次对3.11次单剂量,p < 0.01)。吻合器组的并发症发生率为4%,传统组为11%。吻合器痔切除术仅适用于伴有或不伴有黏膜脱垂的Ⅲ度痔疮患者。传统组由Ⅲ度脱垂或Ⅳ度固定性外痔患者组成。尽管吻合器痔切除术目前已报道有非常可观的效果,但在长期结果公布之前,仍应继续采用已确立 的传统重建手术。