- 期刊
Short Term Outcomes after the Introduction of Ligasure Hemorrhoidectomy Technique to a Regional Hospital
區域醫院導入組織凝集儀痔瘡切除手術技術後的短期成果分析
摘要
Purpose. Milligan-Morgan and Ferguson techniques are well-established standards of hemorrhoidectomy and were referred as traditional methods. Many reports suggest that the Ligasure hemorrhoidectomy has comparable results, with numerous benefits. We designed and implemented a trans-hospital training program to teach surgeons in a regional hospital to perform Ligasure hemorrhoidecotmy. Methods. A surgical team in another hospital experienced with Ligasure hemorrhoidecotmy was invited as trainer. The training program had three phases: pre-training (phase I), live demonstration and on-line counseling (phase II), and independent practice (phase III). The surgical and clinical outcomes in each phase were analyzed. Results. Asignificant increase in case numbers was recorded in phase III. The mean admission days decreased from 2.09 in phase I to 1.21 in phase II, but rebounded to 2.00 in phase III. This change in admission days achieved statistical significance. The mean and maximum visual analog pain scores on the operation day progressively decreased over the training phases (p = 0.00081 and 0.00051, respectively). Three high-risk patients experienced massive postoperative wound bleeding in phase II. Conclusions. The introduction of LigaSure hemorrhoidectomy technique can improve postoperative pain, the complication rate, number of admission days. An increase of patient numbers was observed of surgeons learned and performed Ligasure hemorrhoidectomy. Massive postoperative wound bleeding can happen after LigaSure hemorrhoidectomy in patients with large-sized hemorrhoid piles, liver cirrhosis, or rectal prolapse.
並列摘要
目的：穆勒－摩根術式與佛格森術式是被廣泛接受的痔瘡切除手術方式，一般被稱為傳統方式。許多文獻已經顯示使用組織凝集儀進行痔瘡切除手術可以達到相同效果但是有許多優勢。本院設計並且實行了一個跨院訓練計畫教導區域醫院的外科醫師執行組織凝集儀痔瘡切除手術。方法：一個它院具有豐富的組織凝集儀痔瘡切除手術經驗的團隊被邀請擔任講師，訓練計劃包含三個階段：訓練前期（第一階段）、示範及線上輔導期（第二階段）、與獨立運作期（第三階段），各階段的臨床效益被加以分析。結果：第三階段病案數明顯增加，平均住院日從第一階段的2.09日降到第二階段的1.21日，但是在第三階段回升到2.00日，此變化達到統計學上的意義。手術當日的最大與平均疼痛指數隨著階段推進遞減（p值各為0.00081以及0.00051），在第二階段有三個高風險病人發生術後大量出血。結論：導入組織凝集儀痔瘡切除手術技術可以改善手術疼痛、併發症率、與住院日數。學習並且執行該手術的外科醫師病患數目有增加，大型痔瘡、肝硬化、與直腸脫垂的病人有可能發生術後大量出血。
參考文獻
延伸閱讀
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