Abe Tatsuya, Kunimoto Masao, Hachiro Yoshikazu, Ito Akane, Watanabe Kenji, Ota Shigenori, Ohara Kei, Inagaki Mitsuhiro, Saitoh Yusuke, Murakami Masanori
Department of Proctology, Kunimoto Hospital, Asahikawa, Japan.
Department of Gastroenterology, Kunimoto Hospital, Asahikawa, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):331-339. doi: 10.23922/jarc.2024-034. eCollection 2024.
To date, there have been no reports on the long-term effects of a method that combines external hemorrhoidectomy with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy. This study aimed to investigate the efficacy and safety of external hemorrhoidectomy combined with ALTA sclerotherapy (EA) in reducing postoperative complications associated with conventional hemorrhoidectomy.
EA was performed under sacral epidural anesthesia, and ALTA sclerotherapy was applied to the remaining internal hemorrhoids after resection of the external hemorrhoids. Mixed internal and external hemorrhoids were treated with EA, whereas internal hemorrhoids without external hemorrhoids were treated with ALTA sclerotherapy. The three EA patterns were defined as EA1, EA2, and EA3, depending on the number of EAs performed.
This study included 3,403 patients who underwent EA for grade II-IV mixed hemorrhoids. EA1 was the most common, with 1,789 (52.6%) cases, followed by EA2 (36.2%) and EA3 (11.2%). Postoperative complications occurred in 120 (3.5%) patients and increased with the number of EAs, with fever and bleeding being common in the early postoperative period, and perianal abscess and/or fistula being common after 1 month. The mean postoperative follow-up period was 26.4 months, and 136 (4.0%) patients underwent reoperation for recurrent internal or mixed hemorrhoids. The reoperation rate for EA1 was significantly higher than that for EA2 and EA3. The 5- and 10-year cumulative recurrence-free rates were 92.5% and 67.2%, respectively.
EA is as curative as conventional hemorrhoidectomy and reduces postoperative complications. Therefore, EA is the preferred procedure for patients with mixed hemorrhoids.
迄今为止，尚无关于外剥痔联合硫酸铝钾和鞣酸（ALTA）硬化疗法的长期效果的报道。本研究旨在探讨外剥痔联合ALTA硬化疗法（EA）在减少传统痔切除术相关术后并发症方面的疗效和安全性。
EA在骶管硬膜外麻醉下进行，在外痔切除后对剩余内痔进行ALTA硬化疗法。混合痔采用EA治疗，而无外痔的内痔采用ALTA硬化疗法治疗。根据进行EA的次数，将三种EA模式定义为EA1、EA2和EA3。
本研究纳入了3403例接受EA治疗II-IV度混合痔的患者。EA1最为常见，有1789例（52.6%），其次是EA2（36.2%）和EA3（11.2%）。120例（3.5%）患者发生术后并发症，且并发症发生率随EA次数增加而升高，术后早期常见发热和出血，术后1个月后常见肛周脓肿和/或肛瘘。术后平均随访期为26.4个月，136例（4.0%）患者因复发性内痔或混合痔接受再次手术。EA1的再次手术率显著高于EA2和EA3。5年和10年累积无复发率分别为92.5%和67.2%。
EA与传统痔切除术疗效相当，且能减少术后并发症。因此，EA是混合痔患者的首选手术方式。
