Bove Aldo, Bongarzoni Giuseppe, Palone Gino, Chiarini Stella, Calisesi Enrico Maria, Corbellini Luciano
Department of Surgery, University G. D'Annunzio, Chieti, Italy.
Ann Ital Chir. 2009 Jul-Aug;80(4):299-303.
Haemorrhoidectomy according to Longo potentially reduces post-operative pain and allows an early return to work. The aim of this study was to evaluate the efficacy of the technique, the early and especially late complications, and recurrences, in 150 patients.
Between January 2005 and December 2006, we performed 150 consecutive haemorrhoidectomies with the Longo technique: 82 for third degree haemorrhoids and 68 for fourth degree haemorrhoids. The mean age of patients was 42 years. Every patient had a pre-operative proctoscopy and endoscopy KIT PPH01 (Ethicon Endo Surgery) was used. We evaluated the length of the operation, the post-operative pain, the early and late complications, and the recurrence of the disease. The mean follow up was 52 months (range 36-72).
There was no mortality. The mean length of the operation was 25 minutes with a range of 15 to 45 minutes. Pain, evaluated using the V.A.S. scale, was very light in 114 patients (V.A.S. 2,1) and light in 36 (V.A.S. 3.2). Only 11 (7.5%) patients took painkillers, on demand, for a week after discharge from hospital and 2 patients (1,3%) for more than one month. Early complications (6.6%) were: 5 bleeding (2 after seven days), 4 acute urinary retentions, 1 external haemorrhoid thrombosis and 1 haematoma of the rectus wall. Mean Hospital stay was 2.1 days. Late complications (10%) were: 5 "faecal urgency" which disappeared after six months, 6 moderate asymptomatic strictures, and 4 persistent skin tags. There were 8 recurrences (5.1%), 2 for haemorrhoids of grade 3 e 6 for haemorrhoids of grade 4. All the recurrences appeared within the first 24 months.
The stapled procedure according to Longo is an effective treatment for haemorrhoids. The results for postoperative pain and early return to work are very good. However, special care for haemostasis is essential in order to avoid bleeding. An effective surgical technique prevents late complications, but results after long term follow up show a not insignificant percentage of recurrences that appeared especially in the fourth degree haemorrhoids. Therefore a careful pre-operative exclusion of those patients with a prominent prolax is necessary
根据隆戈（Longo）方法进行的痔切除术可能会减轻术后疼痛，并能使患者早日恢复工作。本研究的目的是评估该技术在150例患者中的疗效、早期尤其是晚期并发症以及复发情况。
在2005年1月至2006年12月期间，我们采用隆戈技术连续进行了150例痔切除术：82例为三度痔，68例为四度痔。患者的平均年龄为42岁。每位患者术前行直肠镜检查，并使用KIT PPH01（爱惜康内镜外科公司）。我们评估了手术时间、术后疼痛、早期和晚期并发症以及疾病复发情况。平均随访时间为52个月（范围36 - 72个月）。
无死亡病例。手术平均时长为25分钟，范围为15至45分钟。使用视觉模拟评分法（V.A.S.）评估疼痛，114例患者疼痛很轻（V.A.S. 2.1），36例患者疼痛较轻（V.A.S. 3.2）。只有11例（7.5%）患者出院后按需服用止痛药一周，2例患者（1.3%）服用超过一个月。早期并发症（6.6%）包括：5例出血（2例在术后七天后出血）、4例急性尿潴留、1例外痔血栓形成和1例直肠壁血肿。平均住院时间为2.1天。晚期并发症（10%）包括：5例“便急”，六个月后消失；6例中度无症状狭窄；4例持续性皮赘。有8例复发（5.1%），3度痔复发2例，4度痔复发6例。所有复发均出现在最初24个月内。
根据隆戈方法进行的吻合器痔上黏膜环切术是一种有效的痔治疗方法。术后疼痛和早日恢复工作的效果非常好。然而，为避免出血，必须特别注意止血。有效的手术技术可预防晚期并发症，但长期随访结果显示复发率不容忽视，尤其是四度痔的复发率较高。因此，术前仔细排除那些有明显脱垂的患者是必要的。
