Gallo Gaetano, Mistrangelo Massimiliano, Passera Roberto, Testa Valentina, Pozzo Mauro, Perinotti Roberto, Lanati Ivan, Lazzari Ivano, Tonello Paolo, Ugliono Elettra, De Luca Emilia, Realis Luc Alberto, Clerico Giuseppe, Trompetto Mario
Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
Gastroenterol Res Pract. 2018 Mar 19;2018:6423895. doi: 10.1155/2018/6423895. eCollection 2018.
Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint.
To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms.
For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4-6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG).
Postoperative thrombosis (SG 1/48 versus CG 5/45) ( < 0.001) and pain after rectal examination ( < 0.001) were significantly reduced at 7-10 days after surgery in the mesoglycan-treated group, permitting a faster return to work ( < 0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug's antithrombotic properties.
The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7-10 days after surgery, permitting a faster return to normal activities.
针对接受开放性痔切除术的患者，已提出了多种疼痛管理策略，但术后疼痛仍是常见的主诉。
确定低聚糖（术后前5天每天一次肌肉注射30毫克，分两瓶，之后30天每天口服50毫克，每日两片）是否会减轻黏膜皮肤桥的水肿，从而改善术后疼痛症状。
在这项前瞻性观察性多中心研究中，5个结直肠转诊中心招募了101例因III - IV度痔病接受电刀痔切除术的患者。根据中度/重度急性术后疼痛短期管理指征，患者被分配接受低聚糖治疗（研究组SG）或推荐的口服剂量的酮咯酸氨丁三醇，每4 - 6小时10毫克，每日不超过40毫克，术后不超过5天，外加软化大便药物（对照组CG）。
在术后7 - 10天，低聚糖治疗组的术后血栓形成（SG组1/48 vs CG组5/45）（<0.001）和直肠检查后的疼痛（<0.001）显著减轻，使得患者能够更快恢复工作（<0.001）；然而，在同一组中，当需要再次入院或意外门诊就诊时被视为相关的术后出血发生率较高，这可能归因于该药物的抗血栓特性。
开放性电刀痔切除术后给予低聚糖可减少术后7 - 10天的血栓形成和疼痛，使患者能更快恢复正常活动。
