Abbasakoor F, Nelson M, Beynon J, Patel B, Carr N D
Department of Surgery, Singleton Hospital, Swansea, UK.
Br J Surg. 1998 Nov;85(11):1522-4. doi: 10.1046/j.1365-2168.1998.00887.x.
Anorectal symptoms after haemorrhoidectomy are common and treatment is often empirical. Because of this, an audit was carried out of the value of anal endosonography in patients with anorectal symptoms after haemorrhoidectomy.
Between May 1993 and February 1997, 16 patients (ten men and six women of median age 56 (range 35-77) years) were investigated by anal endosonography for anorectal symptoms after haemorrhoidectomy which involved anorectal incontinence (n = 10), anal pain (n = 4) and obstructive defaecation (n = 2). The findings were compared with those in a matched group of asymptomatic patients after haemorroidectomy.
Anal endosonography demonstrated an abnormality in 12 symptomatic patients. Of the ten patients with anorectal incontinence, endosonography showed an internal anal sphincter defect (n = 5), a combined sphincter defect (n = 2) and an isolated external anal sphincter defect (n = 1). Normal appearances were seen in all asymptomatic patients. The endosonographic abnormalities of the four patients with anal pain included internal anal sphincter defect (n = 1), extrinsic mass (n = 1), and intersphincteric abscess (n = 1). One of the two patients with obstructive defaecation had an isolated external anal sphincter defect on endosonography.
These results show a high yield of endosonographic abnormalities in patients who experience symptoms after haemorrhoidectomy. In particular, occult sphincter injury as a cause of incontinence in these patients can frequently be demonstrated.
痔切除术后肛门直肠症状很常见，治疗往往是经验性的。因此，对痔切除术后有肛门直肠症状的患者进行了肛门腔内超声检查价值的审计。
1993年5月至1997年2月，对16例患者（10例男性和6例女性，中位年龄56岁（范围35 - 77岁））进行了肛门腔内超声检查，这些患者在痔切除术后出现肛门直肠症状，包括肛门失禁（n = 10）、肛门疼痛（n = 4）和排便梗阻（n = 2）。将检查结果与一组匹配的无症状痔切除术后患者进行比较。
肛门腔内超声检查显示12例有症状患者存在异常。在10例肛门失禁患者中，腔内超声检查显示肛门内括约肌缺陷（n = 5）、联合括约肌缺陷（n = 2）和孤立的肛门外括约肌缺陷（n = 1）。所有无症状患者的检查结果均正常。4例肛门疼痛患者的腔内超声异常包括肛门内括约肌缺陷（n = 1）、外在肿物（n = 1）和括约肌间脓肿（n = 1）。2例排便梗阻患者中有1例在腔内超声检查时发现孤立的肛门外括约肌缺陷。
这些结果表明，痔切除术后出现症状的患者腔内超声检查异常的检出率很高。特别是，这些患者中作为失禁原因的隐匿性括约肌损伤经常可以被发现。
