Raahave Dennis, Jepsen Lars V, Pedersen Ib K
Department of Surgery, Colorectal Laboratory, Copenhagen University North Sealand Hospital, 3000, Helsingore, Denmark.
Dis Colon Rectum. 2008 Mar;51(3):334-41. doi: 10.1007/s10350-007-9102-6. Epub 2008 Jan 19.
Treating hemorrhoids by stapled hemorrhoidopexy has become increasingly common, because the procedure results in less pain and allows the patient to return to work earlier than with open hemorrhoidectomy. However, the durability of stapled hemorrhoidopexy has not been evaluated. This study was designed to assess initial results, analyze complications and failures, and document both the need for repeated procedures and the outcomes of follow-up to five years.
From 1998 to 2004, 258 patients underwent modified stapled hemorrhoidopexy. The appearance of the anus was scored preoperatively, immediately after the procedure, at three months, and at one to five years postoperatively. The anatomy score ranged from 1 (normal anus) to 7 (worst prolapse). We also evaluated operation time, analgesia, staple line position, postoperative pain score, technical failures, postoperative complications, need for repeated procedures, and patient satisfaction. Statistical analyses were used to identify correlations and differences, and the variables were analyzed in relation to the final outcome.
The patients were observed for a median of 34 (range, 18-78) months. The median postoperative pain score was 4 (Visual Analog Scale 1-10) on the day of stapled hemorrhoidopexy; additional external procedures resulted in significantly higher pain (P<0.05). Stapled hemorrhoidopexy was repeated in 31 patients (12 percent), and 38 patients (14.7 percent) had subsequent excisions. Technical failures occurred in 18 of 258 patients (7 percent). The median anatomy score decreased from 6 (range, 3-7) preoperatively to 1 (range, 1-6) at last follow-up, irrespective of one or a repeated stapled hemorrhoidopexy, surgical excision, or technical failure. The risk of reintervention was greatest during the first year after a stapled hemorrhoidopexy. Overall, patient satisfaction was high and correlated significantly with the anatomy score (r=0.46, P<0.05).
The pain after stapled hemorrhoidopexy was low, recovery was rapid, complications were few, and patient satisfaction was high. A recurrent (or persistent) prolapse was alleviated by a repeated stapled hemorrhoidopexy for cure. However, there was a high risk of reintervention after a stapled hemorrhoidopexy, and this should be further evaluated.
吻合器痔上黏膜环切术治疗痔疮越来越普遍，因为该手术疼痛较轻，且患者比开放性痔切除术能更早恢复工作。然而，吻合器痔上黏膜环切术的持久性尚未得到评估。本研究旨在评估初始结果，分析并发症和失败情况，并记录重复手术的必要性以及五年随访结果。
1998年至2004年，258例患者接受了改良吻合器痔上黏膜环切术。术前、术后即刻、术后三个月以及术后一至五年对肛门外观进行评分。解剖学评分范围为1分（正常肛门）至7分（最严重脱垂）。我们还评估了手术时间、镇痛情况、吻合器钉合线位置、术后疼痛评分、技术失败情况、术后并发症、重复手术的必要性以及患者满意度。采用统计学分析确定相关性和差异，并分析变量与最终结果的关系。
患者的中位观察时间为34个月（范围18 - 78个月）。吻合器痔上黏膜环切术当天的术后疼痛评分中位数为4分（视觉模拟评分1 - 10分）；额外的外痔手术导致疼痛显著更高（P<0.05）。31例患者（12%）接受了重复吻合器痔上黏膜环切术，38例患者（14.7%）随后接受了切除术。258例患者中有18例（7%）出现技术失败。末次随访时，解剖学评分中位数从术前的6分（范围3 - 7分）降至1分（范围1 - 6分），无论是否进行一次或重复吻合器痔上黏膜环切术、手术切除或技术失败。吻合器痔上黏膜环切术后第一年再次干预的风险最大。总体而言，患者满意度较高，且与解剖学评分显著相关（r = 0.46，P<0.05）。
吻合器痔上黏膜环切术后疼痛轻微，恢复迅速，并发症少，患者满意度高。复发性（或持续性）脱垂可通过重复吻合器痔上黏膜环切术治愈。然而，吻合器痔上黏膜环切术后再次干预的风险较高，对此应进一步评估。
