Beattie G C, Wilson R G, Loudon M A
Department of Surgery, Royal Infirmary, Edinburgh, UK.
Colorectal Dis. 2002 Nov;4(6):450-4. doi: 10.1046/j.1463-1318.2002.00371.x.
New concepts in the management of haemorrhoidal disease have recently rekindled interest in this common pathology. General and subspecialist colorectal surgeons were surveyed to assess their impact on the current management of haemorrhoids.
A questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Association of Surgeons of Great Britain and Ireland (ASGBI). Regarding indications for surgery, surgical techniques, day case haemorrhoidectomy (DCH) and postoperative treatment regimens. ASGBI members were asked to state their subspecialist interest and estimated time devoted to colorectal practice.
There were 406 (71%) ACPGBI respondents and 483 (68%) ASGBI respondents. Eighty-four (12%) ASGBI respondents performed no elective colorectal surgery. One hundred and ninety-nine (35%) of ACPGBI respondents saw between 6 and 10 new haemorrhoid patients per week whereas three hundred (42%) of ASGBI respondents saw between 1 and 5 per week. Non-operative management included routine advice on fluid and diet by the majority of surgeons, with banding carried out in 79% (ACPGBI) and 75% (ASGBI) and injection sclerotherapy in 61% (ACPGBI) and 56% (ASGBI). The Milligan Morgan haemorrhoidectomy was performed in 265 (46%; ACPGBI) and 336 (47%; ASGBI). ACPGBI members used Submucosal diathermy (148, 26%vs 67, 9%; ASGBI (P < 0.01; chi2 test with Yates correction)) and stapled anoplasty (61, 11%vs 14, 2%; ASGBI (P < 0.01; chi2 test with Yates correction)) more often. DCH was performed in 117 (20%; ACPGBI) and in 48 (7%; ASGBI)(P < 0.01; chi2 test with Yates correction).
In this sample of surgeons, operative management varies according to specialist interest. There was a trend towards day case haemorrhoidectomy. Whilst more surgeons have accepted the use of postoperative techniques to reduce pain, only a small minority have, as yet, adopted new surgical techniques such as stapling.
痔病管理的新理念最近重新引发了人们对这种常见病症的关注。对普通和专科结直肠外科医生进行了调查，以评估这些理念对当前痔病管理的影响。
向英国和爱尔兰结直肠外科学会（ACPGBI）以及英国和爱尔兰外科医生协会（ASGBI）的所有成员发送了一份问卷。问卷内容涉及手术指征、手术技术、日间痔切除术（DCH）和术后治疗方案。还要求ASGBI成员说明他们的专科兴趣以及估计投入到结直肠手术的时间。
ACPGBI有406名（71%）受访者，ASGBI有483名（68%）受访者。84名（12%）ASGBI受访者未进行任何择期结直肠手术。199名（35%）ACPGBI受访者每周诊治6至10例新的痔病患者，而300名（42%）ASGBI受访者每周诊治1至5例。大多数外科医生的非手术治疗包括常规的液体和饮食建议，79%（ACPGBI）和75%（ASGBI）的医生进行套扎治疗，61%（ACPGBI）和56%（ASGBI）的医生进行注射硬化治疗。265名（46%；ACPGBI）和336名（47%；ASGBI）医生进行了Milligan Morgan痔切除术。ACPGBI成员更常使用黏膜下透热疗法（148例，26%对67例，9%；ASGBI（P<0.01；采用Yates校正的卡方检验））和吻合器痔上黏膜环切术（61例，11%对14例，2%；ASGBI（P<0.01；采用Yates校正的卡方检验））。117名（20%；ACPGBI）和48名（7%；ASGBI）医生进行了日间痔切除术（P<0.01；采用Yates校正的卡方检验）。
在这个外科医生样本中，手术管理因专科兴趣而异。有采用日间痔切除术的趋势。虽然更多外科医生已接受使用术后技术来减轻疼痛，但到目前为止，只有一小部分人采用了诸如吻合器等新的手术技术。
