吻合器痔固定术：组织切除的范围及术后早期的临床意义。

Stapled haemorrhoidopexy: extent of tissue excision and clinical implications in the early postoperative period.

机构信息

Hazrate Rasoul Hospital, Colorectal Surgery Unit, University of Iran, Tehran, Iran.

出版信息

Colorectal Dis. 2011 Jun;13(6):697-702. doi: 10.1111/j.1463-1318.2010.02247.x. Epub 2010 Feb 24.

DOI:10.1111/j.1463-1318.2010.02247.x

PMID:20184633

Abstract

AIM

This study quantified prospectively the amount of rectal wall removed during stapled haemorrhoidopexy and assessed its effect on ano-rectal function and health-related quality of life.

METHOD

Thirty-three consecutive patients who underwent stapled haemorrhoidopexy for second- or third- degree haemorrhoids, or for failed medical treatment, in the Department of Surgery and Gastroenterological Sciences at the University of Padova were included. All patients were assessed preoperatively and postoperatively using a structured questionnaire to determine the number of defecations per week, incomplete defecations, time taken to defecate any difficulty in defecating, soiling, the use of drugs and continence. All patients were reassessed at 1 and 2 weeks and at 30 days after the procedure using the Cleveland Global Quality of Life (CGQL) questionnaire. All patients underwent preoperative and postoperative ano-rectal manometry at least 30 days after stapled haemorrhoidopexy.

RESULTS

The median surface area of the resected rectal wall was 10.5 (range, 9-15) mm(2) and the median thickness was 3 (range, 2-4) mm. Muscle tissue was included in all specimens. The median thickness of the resected rectal wall correlated inversely with the rectal volume when the recto-anal inhibitory reflex (RAIR) was initiated during postoperative manometry (ρ = -0.50, P = 0.07). A significant, direct correlation was found between the surface area of the resected rectal wall and the rectal volume during postoperative manometry (ρ = 0.53, P = 0.08) and the use of analgesic drugs after 2 weeks (ρ = 0.63, P = 0.04). Significant correlations were found between being female and postoperative resting pressure (ρ = -0.74, P < 0.01), squeeze pressure (ρ = -0.64, P = 0.01) and maximum tolerated volume (ρ = -0.78, P < 0.01).

CONCLUSION

Stapled haemorrhoidopexy is safe and effective. The thicker the resected rectal wall, the lower the volume of initiation of the RAIR.

摘要

目的

本研究前瞻性地量化了吻合器痔上黏膜环切术中切除的直肠壁的量，并评估其对肛门直肠功能和健康相关生活质量的影响。

方法

在帕多瓦大学外科和胃肠科学系，对 33 例连续接受吻合器痔上黏膜环切术治疗 2 或 3 度痔或经药物治疗失败的患者进行了研究。所有患者均在术前和术后使用结构化问卷进行评估，以确定每周排便次数、不完全排便、排便时间、排便困难、弄脏、药物使用和控便情况。所有患者均在术后 1 周、2 周和 30 天使用克利夫兰全球生活质量（CGQL）问卷进行重新评估。所有患者在吻合器痔上黏膜环切术后至少 30 天行术前和术后肛门直肠测压。

结果

切除的直肠壁表面积中位数为 10.5（范围 9-15）mm²，厚度中位数为 3（范围 2-4）mm。所有标本均包括肌肉组织。在术后测压时，直肠-肛门抑制反射（RAIR）启动时，切除的直肠壁厚度与直肠容量呈负相关（ρ=-0.50，P=0.07）。在术后测压时，切除的直肠壁表面积与直肠容量之间存在显著的正相关（ρ=0.53，P=0.08），与术后 2 周使用止痛药物之间也存在显著的正相关（ρ=0.63，P=0.04）。女性与术后静息压（ρ=-0.74，P<0.01）、收缩压（ρ=-0.64，P=0.01）和最大耐受容量（ρ=-0.78，P<0.01）呈显著负相关。