Managements of an Anorectal Emergency: Experience from a Single Institution

目的急性肛門直腸疼痛是個令人苦惱、坐立難安的情形。在急診室裡，正確的診斷及處置急性肛門直腸痛是個充滿挑戰及棘手的問題。本篇研究的目的，是利用回顧性分析本院的經驗。方法從2010年12月至2012年07月，回顧性收集在本院急診室主訴為肛門痛、屁股痛或會陰痛的患者。關於病患的病史，臨床表現，診斷，影像學，手術治療方式，住院天數和術後追蹤進行分析。結果在急診室裡，急性肛門直腸疼痛病患的比例為0.18%(425/238,391)。在急性肛門直腸疼痛患者中，肛門直腸膿瘍(50.35%)和痔瘡(41.18%)為兩大主要病因且以男性為居多。上述急性肛門直腸疼痛患者中，44.24%(188/425)需要住院接受手術治療。在急診室病床邊施行肛門直腸周圍膿瘍切開引流術有15%的失敗率。在住院接受手術的肛門直長膿瘍患者中，54.10%的病患在手術時就可以發現有廔管形成，而接受廔管切開術。緊急痔瘡切除手術相較於常規痔瘡手術，在手術時間，痔瘡楔形切除的數目，術後的併發症上，兩者是相似的，但卻有較短的住院天數。結論肛門直腸膿瘍和痔瘡危機是肛門直腸急症的兩個主要病因。由經驗豐富的大腸直腸外科醫師執行緊急手術，可以在短暫的住院時間中，快速的解除病人不適的疼痛症狀。

關鍵字

肛門直腸疼痛；肛門直腸膿瘍；痔瘡危機

並列摘要

Purpose. Acute anorectal pain is a distressful situation for a patient. To achieve a correct diagnosis and adequate management of acute anorectal pain in the emergency department is a challenge for physicians. The aim of this study is to perform a retrospective analysis of the management of anorectal emergencies at a single medical center. Methods. The records of patients seen at the emergency department of Chi-Mei Medical Center between December 2010 and July 2012 with a chief complaint of anal, rectal, buttock, or perineal pain were retrospectively reviewed. The diagnosis, management in the emergency department, methods of surgical intervention, days of hospitalization, and follow-up were analyzed. Results. The proportion of patients with acute anorectal pain seen in the emergency department was 0.18% (425/238,391). The major etiologies of acute anorectal pain were anorectal abscesses (50.35%) and hemorrhoids (41.18%), with a male predominance. Of the patients, 44.24% (188/425) required admission for surgical intervention. Bedside incision and drainage of anorectal abscesses had a 15% failure rate. Of anorectal abscess patients, 54.10% had fistula formation at the initial operation and underwent fistulotomy. The operative time, number of wedge resections, and complication rate of emergency hemorrhoidectomy were similar to that of elective hemorrhoidectomy. Emergency hemorrhoidectomy had a significantly shorter hospital stay compared to elective hemorrhoidectomy. Conclusions. Anorectal abscesses and hemorrhoids crisis were the two most common etiologies of anorectal emergencies. With a well-experienced colorectal surgeon, emergent surgical intervention allows rapid relief of a patient's symptoms with a short hospital length of stay.

並列關鍵字

Anorectal pain ； Anoretal abscess ； Hemorrhoidal crisis

參考文獻

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國際替代計量

Managements of an Anorectal Emergency: Experience from a Single Institution

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