Yao Li-qing, Zhong Yun-shi, Xu Jian-min, Zhou Ping-hong, Xu Mei-dong, Song Lu-jun, Liu Hou-bao
Department of General Surgery, Zhongshan Hospital, Department of Surgery, Medical Center, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2006 Jul 1;44(13):897-9.
To evaluate stenosis of the lower rectum following PPH with special respect to potential predictive factors or stenotic events.
A retrospective analysis of 554 consecutive patients, which underwent PPH from July 2000 to December 2004 was performed.
Only patients with follow-up check were evaluated, thus the analysis includes 489 patients (489/554, 88.3%) with a mean follow-up of (324 +/- 18) days. Rectal stenosis was observed in 12 patients (12/489, 2.5%), the median time to stenosis was 89 - 134 (125 +/- 5) days. All the patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that patients with stenosis had significantly more often prior sclerosis therapy for hemorrhoids (58.3% vs. 20.0%, P = 0.02) and severe postoperative pain (25.0% vs. 6.7%, 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 four months after surgery. The majority of the stenosis can be cured through colonoscopy surgery. The predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.
评估吻合器痔上黏膜环切术（PPH）后低位直肠狭窄情况，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月连续接受PPH的554例患者进行回顾性分析。
仅对接受随访检查的患者进行评估，因此分析包括489例患者（489/554，88.3%），平均随访时间为（324±18）天。12例患者（12/489，2.5%）出现直肠狭窄，狭窄发生的中位时间为89 - 134（125±5）天。所有患者均有排便梗阻症状，并通过结肠镜行电灼或球囊扩张狭窄成形术。统计分析显示，狭窄患者既往接受硬化剂治疗内痔的比例显著更高（58.3%对20.0%，P = 0.02），且术后疼痛严重的比例也更高（25.0%对6.7%，P = 0.003）。其他因素，如性别（P = 0.32）、既往内痔手术史（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。早期狭窄发生在术后前四个月内。大多数狭窄可通过结肠镜手术治愈。狭窄的预测因素为既往内痔硬化剂治疗和术后疼痛严重。
