脱垂性血栓性内痔急诊闭合式痔切除术与择期闭合式痔切除术术后早期结果的比较

A comparison of early postoperative results between urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoids and elective closed hemorrhoidectomy.

作者信息

Pattana-arun Jirawat, Wesarachawit Warin, Tantiphlachiva Kasaya, Atithansakul Puttarat, Sahakitrungruang Chucheep, Rojanasakul Arun

机构信息

Division ofColorectal Surgery, Department of Surgery, Chulalongkorn University Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2009 Dec;92(12):1610-5.

PMID:20043562

Abstract

OBJECTIVE

To compare the perioperative complications, analgesics requirement, and length of hospital stay between patients undergoing urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoid and elective closed hemorrhoidectomy.

RESEARCH DESIGN

Retrospective, comparative study.

MATERIAL AND METHOD

All records of the patients who underwent urgent and elective hemorrhoidectomy between January 2000 and December 2005 were reviewed. Perioperative complications (bleeding, urinary retention, post-operative thrombosis, and wound dehiscence), analgesic requirement, and length of hospital stay were analyzed.

STATISTICS

Chi-Square Test and Mann-Whitney U Test.

RESULTS

From 1440 patients, 1184 patients met the inclusion criteria. All were done with closed technique. The indication for urgent hemorrhoidectomy was prolapsed thrombosed hemorrhoid in 416 patients (group 1). The indication for elective hemorrhoidectomy were grade 3 and 4 internal hemorrhoid, external hemorrhoid or combined hemorrhoid in 768 patients (group 2). There was no statistically significant difference in urinary retention and bleeding complication between two groups; 31 patients (7.5%) in group 1 and 69 patients (8.9%) in group 2 experienced urinary retention p = 0.426, five patients (1.2%) in group 1 and 10 patients (1.3%) in group 2 had postoperative bleeding, p = 1.000). On the second postoperative week, wound dehiscence was found in nine patients (2.2%) from group 1 and 15 patients (2%) from group 2. On the fourth week, all the wounds were completely healed without granulation or stricture formation. Post-operative meperidine requirement was significantly lower in the urgent hemorrhoidectomy group (0.84 +/- 0.71 vs. 0.99 + 0.81 mg/kg, p < 0.001). Post-operative length of hospital stay were not statistically different (1.017 +/- 0.129 vs. 1.016 +/- 0.124, p = 0.107).

CONCLUSION

Urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoids may be a preferable option for patients suffering from this condition.

摘要

目的

比较因脱垂性血栓性外痔接受急诊闭合式痔切除术的患者与接受择期闭合式痔切除术的患者的围手术期并发症、镇痛药物需求及住院时间。

研究设计

回顾性比较研究。

材料与方法

回顾2000年1月至2005年12月期间接受急诊和择期痔切除术患者的所有记录。分析围手术期并发症（出血、尿潴留、术后血栓形成及伤口裂开）、镇痛药物需求及住院时间。

统计学方法

卡方检验和曼-惠特尼U检验。

结果

1440例患者中，1184例符合纳入标准。均采用闭合技术。急诊痔切除术的指征为416例脱垂性血栓性外痔患者（第1组）。择期痔切除术的指征为768例3级和4级内痔、外痔或混合痔患者（第2组）。两组间尿潴留和出血并发症无统计学显著差异；第1组31例患者（7.5%）和第2组69例患者（8.9%）发生尿潴留，p = 0.426，第1组5例患者（1.2%）和第2组10例患者（1.3%）发生术后出血，p = 1.000）。术后第二周，第1组9例患者（2.2%）和第2组15例患者（2%）出现伤口裂开。第四周时，所有伤口均完全愈合，无肉芽组织或狭窄形成。急诊痔切除术组术后哌替啶需求量显著较低（0.84±0.71 vs. 0.99 + 0.81 mg/kg，p < 0.001）。术后住院时间无统计学差异（1.017±0.129 vs. 1.016±0.124，p = 0.107）。