Huang Wen-Shih, Lin Paul Y, Chin Chih-Chien, Yeh Chung-Hung, Hsieh Ching-Chuan, Chang Te-Sheng, Wang Jeng-Yi
Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 6, Sec. West, Chia-Pu Road, Putz, Chiayi 613, Taiwan.
Int J Colorectal Dis. 2007 Sep;22(9):1083-9. doi: 10.1007/s00384-007-0271-5. Epub 2007 Mar 2.
To investigate the efficacy and safety of stapled hemorrhoidopexy in treating prolapsed hemorrhoids in patients with liver cirrhosis.
Eight consecutive cases of patients with prolapsed hemorrhoids comorbid with liver cirrhosis, who had intractable response to other interventions, were enrolled in this retrospective study between January 2002 and June 2006 at our institute. Six patients (75%) had Child-Pugh class A liver cirrhosis, whereas only two patients (25%) had class B disease. Rectal varices were identified in three patients (37.5%), and esophageal varices were identified in six patients (75%). Concurrent rectal and esophageal varices existed in three patients (37.5%). The patients underwent stapled hemorrhoidopexy with Proximate PPH-03 in a lithotomy position under spinal/intravenous general anesthesia.
There was no procedure-related mortality or major complications except hemorrhage. Two patients (25%) were complicated with postoperative staple-line bleeding, which was managed with conservative treatment without reoperation. There were no leading symptoms of relapsing during a follow-up period of at least 6 months.
This study may prove that stapled hemorrhoidopexy is a feasible and safe approach for prolapsed hemorrhoids concurrent with liver cirrhosis.
探讨吻合器痔上黏膜环切术治疗肝硬化患者脱垂性痔的疗效及安全性。
2002年1月至2006年6月期间，在我院对8例脱垂性痔合并肝硬化且对其他治疗反应不佳的患者进行了一项回顾性研究。6例患者（75%）为Child-Pugh A级肝硬化，而仅有2例患者（25%）为B级。3例患者（37.5%）发现直肠静脉曲张，6例患者（75%）发现食管静脉曲张。3例患者（37.5%）同时存在直肠和食管静脉曲张。患者在脊髓/静脉全身麻醉下取截石位，采用PPH-03吻合器行吻合器痔上黏膜环切术。
除出血外，无手术相关死亡或严重并发症。2例患者（25%）术后出现吻合口出血，经保守治疗未再次手术。在至少6个月的随访期内，无复发的主要症状。
本研究可能证明吻合器痔上黏膜环切术是治疗肝硬化合并脱垂性痔的一种可行且安全的方法。
