吻合器痔上黏膜环切术：黏膜痔脱垂的组织学、术中形态与个体间解剖变异的相关性

Stapled haemorrhoidopexy: correlation among histology, intraoperative morphology and interindividual anatomic variability in muco-haemorrhoidal prolapse.

作者信息

Luglio Gaetano, Bucci Luigi, D'Antonio Dario, Quarto Gennaro, Benassai Giacomo, Tarquini Rachele, Celentano Valerio, Giglio Marizio Cesare, Massa Salvatore

出版信息

Ann Ital Chir. 2014 Mar-Apr;85(2):143-7.

PMID:24901972

Abstract

PURPOUSE

The Authors correlated intraoperative mucohaemorrhoidal prolapse morphology, specimen histology, anal canal length and purse-string height.

METHODS

Between September-November 2010, 18 patients (9 grade III; 9 grade IV haemorrhoids) underwent stapled haemorrhoidopexy. Mean age was 54 years (range 38-78).Proctoscopic prolapse morphology, anal canal length, pursestring height and external component were evaluated intraoperatively and specimens sent for histology.

RESULTS

Intraoperative findings were as follows: 2/18 patients showed no procidentia, 2/18 'haemorrhoid type' prolapse, 14/18 'rectal type' prolapse. Mean anal canal lenght was 3.5 cm (range 2.5-4.5); mean purse-string height was 4.5 cm from the dentate line (range 3.5-5.5); 10/18 patients carried external component. Histology showed mucosa/submucosa in 4/18 cases, muscolaris propria in 9/18, perivisceral fat in 5/18. No procidentia/'haemorrhoid type' prolapse showed only mucosa/submucosa at histolgy; a 'rectal type' morphology showed at least the muscolaris propria. An anal canal > 3.5 cm related to 'haemorrhoid type' prolapse, a pursestring ≤ 4 cm and mucosa/submucosa at histology. An anal canal ≤ 3.5 cm related to 'rectal type' prolapse, a purse string > 4 cm from dentate line and at least the muscolaris propria. One patient required analgesics for >7 days. At three months, 1/18 patient presented urgency, 2/18 stool clustering. In 1/18 patient a moderate grade of external component persisted.

DISCUSSION

A possible correlation among anoscopic phenotype, specimen histology, pursestring height, might exist and influence clinical outcomes.

CONCLUSIONS

A positive correlation between specimen thickness, purse-string height and 'rectal type' morphology was found. Patients with higher anal canal showed haemorrhoidal pattern of prolapse, a lower purse-string and mucosa/submucosa at histology.Intraoperative prolapsing tissue morphology could represent a further criteria for surgical decision.

摘要

目的

作者将术中黏膜痔脱垂形态、标本组织学、肛管长度和荷包高度进行关联分析。

方法

2010年9月至11月期间，18例患者（9例Ⅲ度；9例Ⅳ度痔）接受了吻合器痔上黏膜环切术。平均年龄为54岁（范围38 - 78岁）。术中评估直肠镜下脱垂形态、肛管长度、荷包高度和外部成分，并将标本送检做组织学检查。

结果

术中发现如下：18例患者中2例无脱垂，2例为“痔型”脱垂，14例为“直肠型”脱垂。平均肛管长度为3.5厘米（范围2.5 - 4.5厘米）；平均荷包高度距齿状线4.5厘米（范围3.5 - 5.5厘米）；18例患者中有10例有外部成分。组织学检查显示，18例中有4例为黏膜/黏膜下层，9例为固有肌层，5例为内脏周围脂肪。无脱垂/“痔型”脱垂在组织学上仅显示黏膜/黏膜下层；“直肠型”形态至少显示固有肌层。肛管＞3.5厘米与“痔型”脱垂、荷包≤4厘米及组织学上的黏膜/黏膜下层有关。肛管≤3.5厘米与“直肠型”脱垂、距齿状线＞4厘米的荷包及至少固有肌层有关。1例患者需要使用镇痛药超过7天。在三个月时，18例患者中有1例出现便急，2例出现大便干结。18例患者中有1例仍有中度的外部成分。