Yao Liqin, Zhong Yunshi, Xu Jianmin, Xu Meidong, Zhou Pinghong
Department of General Surgery, Zhongshan Hospital, Fudan University Medical Center, Shanghai, 200032, People's Republic of China.
World J Surg. 2006 Jul;30(7):1311-5. doi: 10.1007/s00268-005-0484-0.
After it was introduced in China in 2000, the surgical procedure for prolapse and hemorrhoids (PPH) has become a widely accepted for third- and fourth-degree hemorrhoids. Stenosis of the lower rectum is one of the delayed complications. In order to evaluate this specific problem following PPH, we reviewed our data with special reference to potential predictive factors or stenotic events.
A retrospective analysis of 554 consecutive patients that underwent PPH from July 2000 to December 2004 was performed. Only patients with follow-up check were evaluated; therefore 65 patients (11.7%) Hwere lost to follow-up, and the analysis therefore includes 489 patients with a mean follow-up of 324 days (+/-18 days). For statistical analysis, the groups with and without stenosis were evaluated using the chi-square test; using the Kaplan-Meier statistic, the actuarial incidence for rectal stenosis was plotted.
Rectal stenosis was observed in 12 patients (2.5%) in whom the median time to stenosis was 125 (89 approximately 134) days. All patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that two factors were significantly more prevalent among patients with stenosis: prior sclerosis therapy for hemorrhoids (P=0.02) and severe postoperative pain (P=0.003). Other factors, such as gender (P=0.32), prior surgery for hemorrhoids (P=0.11), histological evidence of squamous skin (P=0.77) or revision (P=0.53) showed no significance.
Rectal stenosis is an uncommon event after PPH. Early stenosis will occur within the first 4 months after surgery. In most cases, the stenosis can be cured through colonoscopy surgery. Predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.
吻合器痔上黏膜环切术（PPH）于2000年引入中国后，已成为广泛接受的治疗Ⅲ、Ⅳ度痔的手术方法。直肠下段狭窄是其延迟并发症之一。为了评估PPH术后的这一特殊问题，我们回顾了相关数据，并特别关注潜在的预测因素或狭窄事件。
对2000年7月至2004年12月连续554例行PPH手术的患者进行回顾性分析。仅对有随访检查的患者进行评估；因此，65例患者（11.7%）失访，分析纳入489例患者，平均随访324天（±18天）。统计学分析中，采用卡方检验对有狭窄和无狭窄的组进行评估；采用Kaplan-Meier统计量绘制直肠狭窄的精算发病率。
12例患者（2.5%）出现直肠狭窄，狭窄的中位时间为125（89至134）天。所有患者均主诉排便梗阻，并通过结肠镜行电灼或球囊扩张的狭窄成形术。统计学分析显示，狭窄患者中两个因素更为常见：既往痔疮硬化剂治疗（P = 0.02）和术后严重疼痛（P = 0.003）。其他因素，如性别（P = 0.32）、既往痔疮手术史（P = 0.11）、鳞状皮肤组织学证据（P = 0.77）或再次手术（P = 0.53）均无显著意义。
PPH术后直肠狭窄并不常见。早期狭窄将在术后4个月内出现。在大多数情况下，狭窄可通过结肠镜手术治愈。狭窄的预测因素是既往痔疮硬化剂治疗和术后严重疼痛。
