Johnson D B, DiSiena M R, Fanelli R D
Residency Program in General Surgery, Berkshire Medical Center, 725 North Street, Pittsfield, MA 01201, USA.
Surg Endosc. 2003 Dec;17(12):1990-5. doi: 10.1007/s00464-003-8151-8. Epub 2003 Oct 23.
Circumferential mucosectomy with stapled proctopexy (CMSP) was first introduced in 1993 as a less painful and highly effective alternative to traditional operative hemorrhoidectomy. Although CMSP has many advantages over traditional hemorrhoidectomy, some authorities and insurers continue to regard it as an inpatient procedure and others have been slow to adopt this progressive technique. This study documents the safe and effective outpatient nature of this procedure.
From December 2001 through August 2002, 33 patients with mucosal prolapse and prolapsing internal hemorrhoids were treated using circumferential mucosectomy with stapled proctopexy as outpatients at an ambulatory surgery center. Fourteen (42%) patients were treated using local anesthesia with intravenous sedation, 18 (55%) chose spinal anesthesia, and general anesthesia was used in one patient. Patients were evaluated postoperatively by telephone at 1 and 2 weeks, and seen in clinic at 4 weeks.
One patient (3%) required an emergency department visit for minor postoperative bleeding. None of our elderly patients required emergency department evaluation and none reported significant complications. Four patients (13%) required urinary catheter placement prior to discharge from the surgery center due to urinary retention. One patient (3%) developed an uncomplicated urinary tract infection, which resolved with antibiotic treatment. Two patients were seen earlier than 4 weeks at the surgeon's request; one was immunocompromised from chemotherapy for metastatic carcinoid, and one reported persistent pain during initial telephone follow-up. No complications were identified in either patient, and no additional complications have been noted to date.
CMSP is a safe, effective, time-efficient procedure for patients with mucosal prolapse and prolapsing hemorrhoids that can be performed safely in the ambulatory surgery center setting. Age is not a limiting factor in selecting patients for this safe outpatient procedure.
1993年首次引入吻合器痔上黏膜环切术（CMSP），作为传统手术痔切除术疼痛较轻且高效的替代方法。尽管CMSP相较于传统痔切除术有诸多优势，但一些权威人士和保险公司仍将其视为住院手术，而其他一些人则迟迟未采用这种先进技术。本研究记录了该手术安全有效的门诊性质。
2001年12月至2002年8月，33例黏膜脱垂和内痔脱垂患者在门诊手术中心接受吻合器痔上黏膜环切术治疗。14例（42%）患者采用局部麻醉加静脉镇静，18例（55%）选择脊髓麻醉，1例患者使用全身麻醉。术后通过电话在1周和2周时对患者进行评估，并在4周时进行门诊复查。
1例患者（3%）因术后轻微出血需到急诊科就诊。我们的老年患者均无需到急诊科评估，也无人报告有严重并发症。4例患者（13%）因尿潴留于手术中心出院前需要留置导尿管。1例患者（3%）发生了无并发症的尿路感染，经抗生素治疗后痊愈。2例患者应外科医生要求在4周前就诊；1例因转移性类癌化疗导致免疫功能低下，另1例在最初电话随访时报告持续疼痛。这2例患者均未发现并发症，且迄今为止未发现其他并发症。
对于黏膜脱垂和内痔脱垂患者，CMSP是一种安全、有效、省时的手术，可在门诊手术中心安全进行。年龄不是选择患者进行这种安全门诊手术的限制因素。
