吻合器痔上黏膜环切钉合术与电切术治疗痔脱垂后症状控制的随机临床试验

Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse.

机构信息

Department of Clinical Sciences, Intervention and Technology, CLINTEC, Karolinska Institute, and Department of Gastrointestinal Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden.

出版信息

Br J Surg. 2010 Feb;97(2):167-76. doi: 10.1002/bjs.6804.

DOI:10.1002/bjs.6804

PMID:20035531

Abstract

BACKGROUND

: This multicentre randomized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids.

METHODS

: The study involved 18 hospitals in Sweden, Denmark and the UK. Some 207 patients were randomized to either anopexy or Milligan-Morgan haemorrhoidectomy, of whom 90 in each group were operated on. Patients reported symptoms before surgery and after 1 year. Daily postoperative pain scores were recorded in a patient diary. Surgeons evaluated the anal anatomy before surgery and after 1 year.

RESULTS

: Correction of prolapse in the anopexy and haemorrhoidectomy groups was similar at 1 year (88 and 90 per cent respectively; P = 0.80). Freedom from symptoms was obtained in 44 and 69 per cent respectively (P = 0.002). Stapled anopexy was associated with less postoperative pain, which resolved more quickly (P = 0.004). Significant improvements were noted in anal continence and well-being 1 year after both operations (P < 0.001). Excessive pain was the most common complication after diathermy excision and disturbed bowel function after stapled anopexy.

CONCLUSION

: Haemorrhoidal prolapse was corrected equally by either operation. Diathermy haemorrhoidectomy gave better symptom relief but was more painful. Neither operation provided complete cure but well-being was greatly improved.

REGISTRATION NUMBER

ISRCTN68315343 (http://www.controlled-trials.com).

摘要

背景

本多中心随机临床试验研究了吻合器痔上黏膜钉合术与痔切除术治疗痔的症状改善情况。

方法

该研究涉及瑞典、丹麦和英国的 18 家医院。共有 207 例患者随机分为吻合器痔上黏膜钉合术或Milligan-Morgan 痔切除术组，每组 90 例患者接受手术治疗。患者分别于术前和术后 1 年报告症状。术后每天的疼痛评分由患者日记记录。术前和术后 1 年，外科医生评估肛门解剖结构。

结果

吻合器痔上黏膜钉合术和痔切除术组的脱垂矫正率在术后 1 年相似（分别为 88%和 90%；P=0.80）。分别有 44%和 69%的患者获得症状缓解（P=0.002）。吻合器痔上黏膜钉合术相关的术后疼痛较轻，疼痛缓解更快（P=0.004）。两种手术在术后 1 年均显著改善肛门的控便能力和舒适度（P<0.001）。电切术后最常见的并发症是过度疼痛，吻合器痔上黏膜钉合术后则是排便功能紊乱。