Shanmugam V, Watson A J M, Chapman A D, Binnie N R, Loudon M A
Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Colorectal Dis. 2005 Mar;7(2):172-5. doi: 10.1111/j.1463-1318.2004.00748.x.
Stapled haemorrhoidopexy is increasingly used for the surgical management of prolapsing haemorrhoids. Accurate placement of the staple line is essential to avoid involvement of the internal anal sphincter (IAS) and the pain sensitive squamous epithelium. The aim of this study was to correlate histology with symptomatic outcome after stapled haemorrhoidopexy.
A single pathologist reviewed one hundred and six consecutive rectal mucosal specimens. Each specimen was assessed for the presence of columnar, transitional and squamous epithelium as well as involvement of smooth and skeletal muscle. In November 2003 all patients were sent a previously validated postal questionnaire about haemorrhoidal symptoms and a Cleveland Clinic continence scale. Symptomatic outcome was compared between patients who did or did not have squamous epithelium involvement in their pathology specimens and were analysed by Mann-Whitney U-test.
One hundred and six stapled haemorrhoidopexies were performed between June 2001 and September 2003. Eighty-four patients (79%) returned the questionnaire; 19 patients had squamous epithelium present in the pathology specimens. There was no significant difference between symptom or Cleveland Clinic scores in patients with or without squamous epithelium in their pathology specimens. Some specimens (n = 6) were found to have smooth muscle underlying squamous epithelium; this was interpreted as the presence of internal anal sphincter (IAS) within the specimen. There was no significant difference in Cleveland Clinic scores between this group and those without IAS involvement.
This study has not demonstrated a long-term difference in symptomatic outcome or continence in patients who have squamous epithelium present in their stapled haemorrhoidopexy specimens.
吻合器痔上黏膜环切术越来越多地用于治疗脱垂性痔。吻合器钉合线的准确放置对于避免累及肛门内括约肌（IAS）和疼痛敏感的鳞状上皮至关重要。本研究的目的是将吻合器痔上黏膜环切术后的组织学与症状结局相关联。
一名病理学家对106例连续的直肠黏膜标本进行了检查。对每个标本评估柱状上皮、移行上皮和鳞状上皮的存在情况以及平滑肌和骨骼肌的累及情况。2003年11月，向所有患者发送了一份先前经过验证的关于痔症状和克利夫兰诊所控便量表的邮政问卷。对病理标本中有或没有鳞状上皮累及的患者的症状结局进行比较，并采用曼-惠特尼U检验进行分析。
2001年6月至2003年9月期间进行了106例吻合器痔上黏膜环切术。84例患者（79%）回复了问卷；19例患者的病理标本中存在鳞状上皮。病理标本中有或没有鳞状上皮的患者在症状或克利夫兰诊所评分方面没有显著差异。一些标本（n = 6）被发现鳞状上皮下方有平滑肌；这被解释为标本中存在肛门内括约肌（IAS）。该组与没有IAS累及的组在克利夫兰诊所评分方面没有显著差异。
本研究未证明吻合器痔上黏膜环切术标本中存在鳞状上皮的患者在症状结局或控便方面存在长期差异。
