关于痔手术术后并发症及合并症影响的十年多中心回顾性分析并文献综述
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review.
作者信息
Moldovan Cosmin, Rusu Elena, Cochior Daniel, Toba Madalina Elena, Mocanu Horia, Adam Razvan, Rimbu Mirela, Ghenea Adrian, Savulescu Florin, Godoroja Daniela, Botea Florin
机构信息
Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania.
Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania.
出版信息
World J Clin Cases. 2023 Jan 16;11(2):366-384. doi: 10.12998/wjcc.v11.i2.366.
BACKGROUND
Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise.
AIM
To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities.
METHODS
We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons.
RESULTS
Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fourniers gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chrons disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients.
CONCLUSION
Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.
背景
痔病（HD）在普通人群和医生眼中都被视为低严重程度的病症，但漫长的保守治疗和术后并发症却表明并非如此。
目的
评估不同治疗方案（包括保守治疗和手术治疗）相对于一些已存在的合并症的有效性。
方法
我们在2011年1月至2021年12月期间于两家外科中心（一家私立医院和一家公立医院）进行了一项为期10年的回顾性研究。我们比较了几种治疗方案（如开放式痔切除术、吻合器痔上黏膜环切术、橡皮圈套扎术和红外线凝固术）在并发症发生率和类型方面的疗效和安全性，以及它们与不同已存在合并症（如炎症性肠病（IBD）、抗凝药物（AM）的使用和肝硬化）的相关性。我们还在PubMed上进行了一项为期20年的研究（1263篇文章）以作相关比较。
结果
我们的研究记录了10940例HD患者，其中10241例接受保守治疗，699例接受手术治疗。其中，男女比例为1.3，年龄分布高峰在59至68岁之间（占患者的32%）。在整个研究中，我们记录到即时疼痛发生率为90%，即时出血发生率为1.5%（11例），延迟出血发生率为1.0%（7例），手术部位感染发生率为0.6%。还存在尿潴留，发生率为0.2%的患者，肛门狭窄发生率为1%，大便失禁发生率为0.5%的患者（4例）。我们未记录到诸如福尼尔坏疽或直肠阴道穿孔等严重并发症。IBD占患者的6%，其中溃疡性结肠炎占12%，克罗恩病占10.5%。6.6%的患者使用AM，在接受手术治疗的患者中导致4%的即时出血和2%的延迟出血。
结论
我们的研究确定，最常见的并发症（疼痛、尿潴留、出血和狭窄）与每种手术技术和已存在的合并症相关。
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