Zmora O, Colquhoun P, Abramson S, Weiss E G, Efron J, Vernava A M, Nogueras J J, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
Surg Endosc. 2004 May;18(5):757-61. doi: 10.1007/s00464-003-8141-x. Epub 2004 Jan 23.
The procedure for prolapsing hemorrhoids (PPH) is a new surgical method for the treatment of symptomatic hemorrhoids. In cases of recurrent prolapse, the performance of a second PPH may result in a ring of mucosa and submucosa between the two circular staple lines. In this study, we used a porcine model to assess whether PPH can be safely performed twice.
Five adult pigs underwent two PPH procedures in one session, leaving a ring of approximately 1 cm of mucosa between the two staple lines. One month later, the pigs were examined under anesthesia. The anal canal was assessed using the following four methods: (a) clinical examination, (b) evaluation of mucosal blood perfusion at different levels of the anal canal via a laser Doppler flow detector, (c) measurement of concentrations of hydroxyproline and collagen to check for fibrosis, and (d) histopathological examination.
At the completion of the study period, all five pigs showed no clinical evidence of anorectal dysfunction. On examination under anesthesia 1 month after surgery, there was no evidence of anal stenosis in any of the pigs. The mean mucosal blood flow between the two staple lines did not differ significantly from the flow measured proximally and distally (394 vs 363 and 339 flow units, respectively; p = NS). The collagen levels, based on hydroxyproline concentration, were 81 mcg/mg between the staple lines, compared to 82 and 79 proximally and distally, respectively ( p = NS). There was no significant difference in degree of fibrosis, as assessed histopathologically, between specimens taken from the ring between the staple lines and specimens taken from the area external to the staple lines.
The results of this porcine model suggest that a second synchronous PPH is feasible. A controlled experience involving human subjects is required to determine the safety and usefulness of this technique in cases of metachronous application for recurrent or residual hemorrhoids.
吻合器痔上黏膜环切术（PPH）是一种治疗症状性痔的新型手术方法。在痔复发脱垂的情况下，再次进行PPH手术可能会在两条环形吻合钉线之间形成一圈黏膜和黏膜下层。在本研究中，我们使用猪模型来评估PPH是否可以安全地进行两次。
5只成年猪在一次手术中接受了两次PPH手术，两条吻合钉线之间保留约1 cm的黏膜环。1个月后，在麻醉下对猪进行检查。通过以下四种方法评估肛管：（a）临床检查；（b）使用激光多普勒血流探测器评估肛管不同水平的黏膜血流灌注；（c）测量羟脯氨酸和胶原蛋白浓度以检查纤维化情况；（d）组织病理学检查。
在研究期结束时，所有5只猪均未表现出肛门直肠功能障碍的临床证据。术后1个月在麻醉下检查时，未发现任何一只猪有肛门狭窄的迹象。两条吻合钉线之间的平均黏膜血流与近端和远端测量的血流相比，差异无统计学意义（分别为394、363和339血流单位；p = 无显著性差异）。基于羟脯氨酸浓度的胶原蛋白水平，吻合钉线之间为81 mcg/mg，近端和远端分别为82和79 mcg/mg（p = 无显著性差异）。从吻合钉线之间的环中取出的标本与从吻合钉线外部区域取出的标本相比，经组织病理学评估的纤维化程度无显著差异。
该猪模型的结果表明，第二次同步PPH是可行的。需要进行涉及人类受试者的对照试验，以确定该技术在复发性或残留性痔分期应用情况下的安全性和有效性。
