Slawik S, Kenefick N, Greenslade G L, Dixon A R
Department of Colorectal Surgery, North Bristol NHS Trust, Bristol, UK.
Colorectal Dis. 2007 May;9(4):352-6. doi: 10.1111/j.1463-1318.2006.01163.x.
We have audited our 5 years experience of circumferential-stapled haemorrhoidopexy (PPH).
A prospectively collected electronic data base of our 5-year experience to September 2005 has been examined.
A total of 357 consecutive patients (220 - 62% women, median age 46 years; range 28-92) with symptomatic third- and fourth-degree haemorrhoids (ratio 222:135) have undergone a stapled haemorrhoidopexy/rectal mucosectomy. One hundred and thirty-two (37%) had failed previous banding; 42 (12%) had undergone a Milligan-Morgan haemorrhoidectomy in the past. All but one was performed under general anaesthetic. Mean duration of surgery was 15 min (range 11-40); 299 (84%) were planned day cases (three patients were admitted overnight for pain relief (2) and retention of urine) and 57 were planned successful overnight stays. Reactive postoperative bleeding requiring a blood transfusion occurred in three patients (0.8%): one returned to theatre (0.2%). Three patients (0.8%) had a secondary haemorrhage requiring a hospital visit, one was admitted overnight. Four patients complaining of severe pain were managed in the community. Transient urgency was reported in 92 patients (26%); 58 (63%) were men, faecal impaction 4 (1.1%), minor staple line stenosis requiring dilatation 5 (1.4%), peri-anal sepsis from an associated untreated chronic anal fissure 1 (0.2%). Normal work was resumed between 3 and 31 days (median 7). Five patients re-presented with recurrent symptoms between 14 & 18 months: further treatment comprised a repeat PPH in three (one was very painful), banding 1 and reassurance alone. A further patient re-presented with minor soiling which responded to physiotherapy.
Stapled haemorrhoidopexy/rectal mucosectomy is a safe, effective and predictable treatment of third- and fourth- degree haemorrhoids and in the majority of patients can be carried out on a day case basis.
我们回顾了5年的吻合器痔上黏膜环切术（PPH）经验。
对前瞻性收集的截至2005年9月的5年经验的电子数据库进行了检查。
共有357例连续性患者（220例女性，占62%，中位年龄46岁；范围28 - 92岁）患有有症状的三度和四度痔疮（比例为222:135），接受了吻合器痔上黏膜环切术/直肠黏膜切除术。132例（37%）既往套扎治疗失败；42例（12%）过去曾接受过Milligan - Morgan痔切除术。除1例患者外，其余均在全身麻醉下进行手术。平均手术时间为15分钟（范围11 - 40分钟）；299例（84%）计划为日间手术（3例患者因疼痛缓解（2例）和尿潴留而留院过夜），57例计划成功留院过夜。3例患者（0.8%）发生需要输血的术后反应性出血：1例返回手术室（0.2%）。3例患者（0.8%）发生继发性出血需要就医，1例留院过夜。4例主诉严重疼痛的患者在社区进行了处理。92例患者（26%）报告有短暂尿急；58例（63%）为男性，4例（1.1%）发生粪便嵌塞，5例（1.4%）出现需要扩张的轻微吻合器钉合线狭窄，1例（0.2%）因未治疗的相关慢性肛裂出现肛周感染。术后3至31天（中位时间7天）恢复正常工作。5例患者在14至18个月之间再次出现复发症状：进一步治疗包括3例重复PPH（1例非常疼痛），1例套扎治疗，1例仅给予安慰。另1例患者再次出现轻微便污，经物理治疗后好转。
吻合器痔上黏膜环切术/直肠黏膜切除术是治疗三度和四度痔疮的一种安全、有效且可预测的方法，在大多数患者中可作为日间手术进行。
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