Diana Giuseppe, Guercio Giovanni, Cudia Bianca, Ricotta Calogero
Università degli Studi di Palermo- Dipartimento di Chirurgia Generale, d'Urgenza e dei Trapianti d'Organo- Via Liborio Giuffrè n degrees 5- 90100- Palermo- Italy.
BMC Surg. 2009 Oct 24;9:16. doi: 10.1186/1471-2482-9-16.
Over the last few years, there has been increasing attention on surgical procedures to treat haemorrhoids. The Milligan-Morgan haemorrhoidectomy is still one of the most popular surgical treatments of haemorrhoids. The aim of the present work is to assess postoperative pain, together with other early and late complications, after Milligan-Morgan haemorrhoidectomy as we could observe in our experience before and after performing an internal sphincterotomy.
from January 1980 to May 2007, we operated 850 patients, but only 699 patients (median age 53) were included in the present study because they satisfied our inclusion criteria. The patients were divided into two groups: all the patients operated on before 1995 (group A); all the patients operated on after 1995 (group B). Since 1995 an internal sphincterotomy of about 1 cm has been performed at the end of the procedure. The data concerning the complications of these two groups were compared. All the patients received a check-up at one and six months after operation and a telephone questionnaire three years after operation to evalue medium and long term results.
after one month 507 patients (72.5%) did not have any postoperative complication. Only 192 patients (27.46%) out of 699 presented postoperative complication and the most frequent one (23.03%) was pain. The number of patients who suffered from postoperative pain decreased significantly when performing internal sphincterotomy, going from 28.8% down to 10.45% (chi(2): 10,880; p = 0,0001); 95% Confidence Interval (CI) 24.7 to 28.9 (group A) and 10.17 to 10.72 (group B). In 51 cases (7.29%) urinary retention was registered. Six cases of bleeding (0.85%) were registered. Medium and long term follow up did not show any difference among the two groups.
internal sphincterotomy: reduces significantly pain only in the first postoperative period, but not in the medium-long term follow up; does not increase the incidence of continence impairment when performed; does not influence the incidence of the other postoperative complications especially as regard medium and long term results.
在过去几年中，治疗痔疮的外科手术受到越来越多的关注。Milligan-Morgan痔切除术仍然是最受欢迎的痔疮外科治疗方法之一。本研究的目的是评估Milligan-Morgan痔切除术后的疼痛以及其他早期和晚期并发症，这是我们在进行内括约肌切开术前后的经验中所能观察到的。
从1980年1月至2007年5月，我们共为850例患者进行了手术，但本研究仅纳入了699例患者（中位年龄53岁），因为他们符合我们的纳入标准。患者分为两组：1995年以前接受手术的所有患者（A组）；1995年以后接受手术的所有患者（B组）。自1995年起，在手术结束时进行约1厘米的内括约肌切开术。比较两组的并发症数据。所有患者在术后1个月和6个月接受检查，并在术后3年接受电话问卷调查以评估中长期结果。
1个月后，507例患者（72.5%）没有任何术后并发症。699例患者中只有192例（27.46%）出现术后并发症，最常见的并发症（23.03%）是疼痛。进行内括约肌切开术时，术后疼痛患者的数量显著减少，从28.8%降至10.45%（卡方值：10,880；p = 0,0001）；95%置信区间（CI）为24.7至28.9（A组）和10.17至10.72（B组）。记录到51例（7.29%）尿潴留。记录到6例出血（0.85%）。中长期随访显示两组之间没有差异。
内括约肌切开术：仅在术后初期显著减轻疼痛，但在中长期随访中没有；进行该手术时不会增加大便失禁障碍的发生率；不影响其他术后并发症的发生率，尤其是从中长期结果来看。
