- 期刊
區域醫院痔瘡手術的經驗
Characteristics of Hemorrhoidectomy in a Community Hospital
摘要
目的：本研究之目的在於探討門診中常見的嚴重痔瘡患者採用諧波手術刀手術治療之預後。方法：本研究對象於民國九十三年一月至六月，因第三度到第四度脫出性痔瘡且併有大型外痔或栓塞性外痔之170位採用諧波手術刀手術治療的病人，除性別、年齡、住院天數、手術時問、切除痔核數等基本資料描述外，亦評估其手術時間、術後併發症如尿滯留、出血、疼痛、括約肌功能等。結果：170位病人中女性稍多於男性，平均年齡為45.8歲，手術時間平均為26.97分鐘，平均每個病患所切除痔核數為2.77顆。9.41％之患者需使用單次導尿，但無使用留置導尿管之情形。研究中僅有38.24％使用非類固醇止痛針劑，而且其四分之三僅使用一劑。住院期間所有病人皆無因出血而需外科處置，出院後的追蹤亦只有1.76％因非預期之肛門出血量而至急診處置，無手術止血或再住院之情形。住院天數平均為三天。結論：痔瘡產生之症狀，常使患者生活品質變差，少部份必需手術之患者，若因術後併發症而使病人有更多傷害，將使手術之意義盡失，所以專科醫師實行手術需謹慎，本研究雖顯示，使用諧波手術刀可使各項併發症減少，但為求手術之預後更理想，大腸直腸外科專科醫師對於器械的選擇，手術的熟練及病人術前術後的衛生教育，都必需以最嚴謹的態度來處理。
並列摘要
Objectives: Hemorrhoidectomy is one of the most commonly performed operations anorectoal. The aim of this study was to evaluate the incidence of postoperative complications often hemorrhoidectomy at a regional hospital. Methods: 170 connectives cases of harmonic scalpel hemorrhoidectomy were studied in a retrospective manner. The admission days, operating time, amount of resented piles, post-operative foley insertion, post-operative analgesic requirement, and other post-operative complications were recorded. Results: A total of 170 patients expierenced hemorrhoidectomy. Female patients are sliguly more than male patients. Average age was 45.8 y/o. The median duration of operation was 26.97 minutes. Average resected piles of patients were 2.77. Only 9.41% patients need temporary foley catheter for their complications of urinary retention 38.24% of patients required non-steroid injection for pain relief. Most of them only required one shot. No any patient underwent emergency management for unexpected anal bleeding post-operatively at hospital. Only 3 patients (1.76%) experienced more amount of anal bleeding after 6 weeks follow up period. Conclusions: Harmonic scalpel hemorrhoidectomy is a safe surgical modality, and post-operative complication rate compare favorably with previously published studied. Despite we have rather good result, hemorrhoidectomy is still a operation which need cautious attitude of colon and rectal surgeon. (Full text in Chinese)