- 期刊
Short Term Result with High Satisfaction of Stapled Hemorrhoidopexy for Grade III and IV Hemorrhoids: A Five Year Single-center Experience from 501 Cases
以痔瘡環狀切除手術治療第三、四級痔瘡患者術後高滿意度結果分析
摘要
Purpose. Hemorrhoids are typical cushion structure in anal canal. Conservative treatments are reserved for first- and second-degree hemorrhoids and operative hemorrhoidectomies are performed on patients with symptomatic third- and fourth-degree hemorrhoids. Stapled hemorrhoidopexy (SH) has been widely accepted; however, data describing long-term complications after SH is limited. Our study aimed to expand the understanding of clinical outcomes and share our experiences to solve post-operative stenosis. Methods. We performed a retrospective cohort analysis using prospectively collected data, including patients who underwent SH at Songshan Branch, Tri-Service General Hospital, National Defense Medical Center between January 1, 2012, and December 31, 2016. Patients undergoing this procedure for grade III or IV mucosal-hemorrhoidal prolapse were included. Patient characteristics were analyzed. Results. We conducted 501 cases in our study. SH was more common among women (318 cases; 63.4%) than men (183 cases; 36.6%) and grade IV (329 cases; 65.6%) than grade III (172 cases; 34.4%). The overall incidence of surgical complications was 19% (95 cases): post-operative bleeding (10 cases; 2%); urinary retention (41 cases; 8.2%); post-operative fever (7 cases; 1.4%); anal thrombosis (7 cases; 1.4%); anal stenosis (23 cases; 4.6%); fecal urgency/tenesmus (7 cases; 1.4%). Moreover, grade III or grade IV mucosal-hemorrhoidal prolapse recurrences developed in 18 patients (3.6%). No active rectal bleeding or suture line dehiscence was found during the outpatient visits. There are 55 cases (10.9%) who received re-entry surgery; 4 cases (0.8%) required to check bleeding; 26 cases (5.2%) with anal stenosis and obstructed defecation after SH, they underwent trans-anal release of the stricture, removing staples at the 3 and 9 o'clock positions; 13 cases (2.6%) underwent RBL; 7 cases (1.4%) underwent Ferguson's hemorrhoidectomy, and five (1%) underwent SH again. Few patients reported severe pain after one week of treatment. About 90% satisfaction was recorded for SH one year after surgery. Conclusion. Although many post-operative complications were recorded, our study demonstrated that SH became a primary method to treat the pro-apse of internal hemorrhoids due to high patient satisfaction and a lower risk for complications. We also shared our experience to performed anoplasty for patients with anal stenosis after SH successfully. Further large-scale prospective studies are needed to investigate these complications and compare different methods of managing prolapsed hemorrhoids.
並列摘要
目的：針對第三、四級有症狀痔瘡患者，接受痔瘡環狀切除手術（SH）後併發症分析，及術後肛門狹窄的治療經驗。方法：以回溯性世代研究，統計2012年1月到2016年12月，501例接受SH治療。結果：501例接受SH個案，女性高於男性，第四級痔瘡比第三級常見。有95例手術併發症（19%）：包括術後出血、尿滯留、術後發燒、肛門血栓、狹窄、裡急後重。此外，18例（3.6%）第三或第四級痔瘡復發。55例（10.9%）接受重返手術：包含止血手術、肛門狹窄整形術、橡皮筋結紮、再次傳統痔切除及SH。很少患者在治療一周後劇烈疼痛。術後一年後，患者對SH滿意度約為90%。結論：SH作為治療內痔脫垂的主要方法，因術後滿意度高且併發症風險較低。我們更分享SH後，肛門狹窄患者接受肛門整形術的經驗。
參考文獻
延伸閱讀
- Chen, C. W., Jao, S. W., Wu, C. C., Lee, T. Y., Feng, C. C., Lai, H. J., & Hsiao, C. W. (2008). 比較痔瘡切除術在靜脈全身麻醉與朦朧麻醉下之手術結果. 中華民國大腸直腸外科醫學會雜誌, 19(2), 33-40. https://doi.org/10.6312/SCRSTW.2008.19(2).09624
- 趙玉婷（2020）。不同麻醉方式用於痔瘡及肛門瘻管手術後疼痛及併發症相關性之探討〔碩士論文，義守大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0074-0508202020582200
- Chen, C. W., Chen, C. M., & Hsiao, K. H. (2014). 比較痔瘡切除術在靜脈全身麻醉與脊椎麻醉之下手術結果. 中華民國大腸直腸外科醫學會雜誌, 25(3), 85-91. https://doi.org/10.6312/SCRSTW.2014.25(3).10312
- 嚴玉華、吳重慶、牟聯瑞（2004）。實施臨床路徑對痔瘡切除手術醫療資源利用的影響。秀傳醫學雜誌，5(3&4)，111-117。https://www.airitilibrary.com/Article/Detail?DocID=15610497-200410-5-3&4-111-117-a
- Chou, T. H., Liang, J. T., Huang, J., & Lee, P. H. (2008). 吻合器痔瘡手術之短期及長期結果. 中華民國大腸直腸外科醫學會雜誌, 19(1), 16-21. https://doi.org/10.6312/SCRSTW.2008.19(1).09617