Conzo G, Buffardi R, Brancaccio U, Astarita G, Palazzo A, Esposito M G, Celsi S
IV Divisione di Chirurgia Generale e di Endocrinochirurgia, Facoltà di Medicina e Chirurgia, Seconda Università degli Studi di Napoli.
Ann Ital Chir. 2004 Nov-Dec;75(6):655-9; discussion 659-60.
In the treatment of hemorroidal prolapse, stapled hemorrhoidopexy, according to the Longo's technique, represents an innovative and interesting procedure. The Authors consider own experience in the years 2001-2002, estimating preliminary results in the treatment of 50 patients affected by hemorrhoidal disease classified as III-IV grade, associated with mucosal prolapse, rectocystocele in 5 cases, anal fissures in 6 and hyperplastic polyp in 1. The patients were submitted to mucosal prolapsectomy with mechanical stapler (PPH 01-33 Ethicon), applying haemostatic stitch on suture line, apart from intraoperative bleeding, associated to closed anal sphincterotomy in 6 cases, and resection of anal hyperplasic polyp in 1. In 5 cases of rectocystocele a Burch's culposuspension was associated to a stapled transanal rectal resection (STARR). After 3 and 12 months the Authors performed ano-rectoscopy, anal manometry and defecography. Mean operative time was 45 minutes (range 20'-130') and mean hospital stay was 3 days (range 2-6 days). In the early postoperative course urinary ritention in 4 cases, treated with temporary catheterization in 3 and permanent for 72 hours in 1, was observed. Only 1 patient, was reoperated in day-surgery and with loco-regional anesthesia for residual fibrous hemorroid. Bleeding, severe pain, anal stenosis, impairment of continence were not observed. According to the Literature data, our experience confirm that mucoprolapsectomy represents an innovative, safe, simple and definitive operation in the treatment of hemorrhoids disease. In case of rectal prolapse associated to external fibrous hemorroids, a combined surgical treatment is requested in order to achieve better results.
在痔脱垂的治疗中，根据隆戈技术进行的吻合器痔上黏膜环切术是一种创新且有趣的手术方法。作者回顾了2001年至2002年的自身经验，评估了对50例患有III - IV级痔病且伴有黏膜脱垂的患者的初步治疗结果，其中5例伴有直肠前突，6例伴有肛裂，1例伴有增生性息肉。患者接受了使用机械吻合器（Ethicon公司的PPH 01 - 33）进行的黏膜环切术，在缝合线上进行止血缝合，除术中出血外，6例患者同时进行了闭合式肛门括约肌切开术，1例患者切除了肛门增生性息肉。5例直肠前突患者在进行吻合器经肛门直肠切除术（STARR）的同时联合了伯奇阴道悬吊术。术后3个月和12个月，作者进行了肛门直肠镜检查、肛门测压和排粪造影。平均手术时间为45分钟（范围为20分钟至130分钟），平均住院时间为3天（范围为2至6天）。术后早期观察到4例患者出现尿潴留，其中3例通过临时导尿治疗，1例永久性导尿72小时。仅1例患者在日间手术中因残留纤维性痔接受了局部区域麻醉下的再次手术。未观察到出血、严重疼痛、肛门狭窄和控便功能障碍。根据文献数据，我们的经验证实黏膜环切术是治疗痔病的一种创新、安全、简单且有效的手术方法。对于伴有外部纤维性痔的直肠脱垂病例，需要联合手术治疗以获得更好的效果。
