Angelone Giovanni, Giardiello Cristiano, Prota Carmine
General and Minimally Invasive Surgery Unit, S. Maria della Pietà Hospital, Casoria, Naples, Italy.
Chir Ital. 2006 Nov-Dec;58(6):753-60.
Stapled hemorrhoidopexy (SH) presents a number of complications which differ from those of traditional haemorrhoidectomy (Milligan-Morgan, diathermy haemorrhoidectomy). The follow-up shows better symptom control than other surgical techniques. Four hundred and forty-nine patients with haemorrhoids of all degrees and mucosal rectal prolapse were treated at our institution over a five-year period (1999-2004). Patients were assessed by structural interview to assess their symptoms before and after surgery, and surgical and functional outcome was assessed at 1, 3, 6, 12 and 24 months. A visual analog scale was used for postoperative pain scoring. Patient's satisfaction is the best response to all criticism. Bleeding in the early postoperative period occurred in 3.9% of all patients and in 7 cases (1.5%) reoperation was necessary. Urge to defecate, although present in 14% of patients, disappears in a few weeks. Severe pain, when present, may depend on technical failure or learning curve. Complete or incomplete recurrence occurred in 10 cases (2.2%). We had one case of rectovaginal fistula in a young woman. In 3 cases we underestimated the extent of the mucosal prolapse and the patients were reoperated on by stapled transanal rectal resection after one (2 patients) and two years. Stapled hemorrhoidopexy is a significantly less painful operation and offers significant advantages in terms of hospital stay and symptom control in the long term, making for a significantly earlier return to work. The complications are similar to those of other techniques and are easily resolved. The unusual complications described (rectal perforation, pelvic sepsis, rectovaginal fistulas) might suggest that the operation should be performed by experienced colorectal surgeons who are familiar with the technique and aware of the possible complications.
吻合器痔上黏膜环切术（SH）存在一些与传统痔切除术（Milligan-Morgan术、电凝痔切除术）不同的并发症。随访显示，该术式在症状控制方面优于其他手术技术。在五年期间（1999 - 2004年），我们机构共治疗了449例不同程度痔疮及直肠黏膜脱垂患者。通过结构化访谈评估患者手术前后的症状，并在术后1、3、6、12和24个月评估手术及功能结果。采用视觉模拟量表对术后疼痛进行评分。患者的满意度是对所有批评的最佳回应。术后早期出血发生在3.9%的患者中，7例（1.5%）需要再次手术。便意，尽管在14%的患者中存在，但在几周内会消失。严重疼痛若出现，可能取决于技术失误或学习曲线。10例（2.2%）出现了完全或不完全复发。我们有1例年轻女性发生了直肠阴道瘘。3例中，我们低估了黏膜脱垂的程度，1例（2例患者）和2年后，这些患者通过吻合器经肛门直肠切除术再次手术。吻合器痔上黏膜环切术是一种疼痛明显较轻的手术，在住院时间和长期症状控制方面具有显著优势，能使患者显著更早重返工作岗位。其并发症与其他技术相似，且易于解决。所描述的不常见并发症（直肠穿孔、盆腔感染、直肠阴道瘘）可能表明该手术应由熟悉该技术并了解可能并发症的经验丰富的结直肠外科医生进行。
