内痔的病理形态改变特征及其意义

目的 探讨痔病患者的肛垫是否存在病变及其组织形态改变特征及意义。方法 采用HE染色、弹力纤维染色法,以正常肛垫组织为质量控制,对比研究24例Ⅲ度内痔患者的相对正常肛垫和痔病组织,观察其形态学变化特征。结果 相对正常肛垫组织中窦状血管结构良好,痔病组织内窦状血管出现结构破坏、组织退行性变、血管内和（或）外弹力板中断和破坏,另外还存在血栓形成和其继发的组织缺血缺氧改变。痔静脉扩张不常见。相对正常肛垫组织中肌纤维、弹性纤维形态较规则、密集,断裂和变形少见,而痔组织的Trietz肌、弹性纤维排列紊乱、疏松,呈明显的断裂、变性等异常。覆盖痔组织的黏膜存在明显的损害。结论 痔病患者的肛垫是病理性肛垫,其病变包括窦状血管结构破坏和血栓形成,Treitz肌和弹力纤维的排列紊乱、疏松断裂等退行性变,还包括痔表面黏膜的损害。这些病理形态改变是痔发生、发展的重要基础。     

直针手缝痔固定术与直肠黏膜环切钉合术治疗Ⅲ、Ⅳ度痔的临床疗效分析

目的 比较直针手缝痔固定术(straight-needle hand-sewing heamorroidpexy,HHP)和直肠黏膜环切术(procedure for prolapse and heamorroids,PPH)治疗Ⅲ～Ⅳ度痔的近期及远期临床疗效.方法 按完全随机对照分组原则将800例Ⅲ～Ⅳ度痔分为HHP术组(385例)和PPH术组(415例),观察并比较两组患者术后近期及远期临床效果.数据采用t检验及x2检验.结果 手术时间HHP组(35.1 ±6.2)min,PPH组(20.7±5.1)min;住院时间HHP组(4.8±2.2)d,PPH组(5.5±2.1)d,两组比较差异无统计学意义.术后疼痛采用视觉模拟评分(visual analogue scale,VAS)(≥5分为重度疼痛),≥5分者HHP组45例(占12.1％);PPH组128例(占31.8％);术后平均恢复工作生活时间,HHP组(5.2±2.3)d,PPH组(10.2±2.4)d;术后并发症(包括出血、痔核突出及吻合口狭窄等需要再次手术者),HHP组5例(0.01％),PPH组17例(0.51％);住院总费用HHP组平均为3520.2元,PPH组平均为8925.2元;患者满意度,HHP组93.9％,PPH组83.1％.统计学分析在近期疗效各指标中,HHP组均明显优于PPH组.术后随访2～5年,HHP组随访278例,PPH组随访292例.术后需要再次手术者中,便血HHP组17例(6.1％),PPH组44例(15.1％);痔核脱出HHP组12例(4.3％),PPH组52例(17.8％),两组比较差异亦有统计学意义(x2 =4.25,P＜0.05).在排便功能方面(如排便感觉异常、便秘、便急或大便失禁等)两组无明显差异.结论 与PPH术相比,HHP术具有安全、痛苦小、费用低、并发症少及患者满意度高等优点,值得推广.     

RPH联合外剥内扎术治疗Ⅱ～Ⅲ期混合痔疗效观察

目的探讨自动套扎术（RPH）联合外剥内扎术治疗Ⅱ～Ⅲ期混合痔的临床疗效。方法采用RPH联合传统外剥内扎术治疗混合痔101例（治疗组）,与同期单纯采用外剥内扎术治疗85例（对照组）相比较,观察治愈率、术后疼痛指数、并发症、创面愈合时间等指标,评价其治疗效果。结果治疗组治愈率优于对照组（P〈0．05）,差异有统计学意义,在术后疼痛指数、并发症、平均愈合时间上两组无明显差别（P〉0．05）。结论RPH联合外剥内扎术可以提高Ⅱ、Ⅲ期混合痔的治愈率。     

自动痔疮套扎术治疗轻中度痔疮的临床疗效分析

目的探讨自动痔疮套扎术治疗轻、中度痔疮的临床疗效。方法选取轻、中度痔疮患者600例,分为两组,其中观察组310例,给予自动痔疮套扎治疗,对照组290例,给予微波辐射治疗。对两组患者治疗效果、治疗时间、创面愈合时间、发生出血、水肿以及复发者进行统计并比较。结果观察组患者治愈率明显高于对照组;观察组治疗时间及创面愈合时间均明显短于对照组;术后发生出血、水肿以及复发者均明显少于对照组。两组差异有统计学意义(P<0.05)。结论对轻、中度痔疮患者采用自动痔疮套扎术治疗安全有效。     

Stapled Hemorrhoidopexy: The Aga Khan University Hospital Experience

Background/Aim:

Stapled hemorrhoidopexy for prolapsing hemorrhoids is conceptually different from excision hemorrhoidectomy. It does not accompany the pain that usually occurs after resection of the sensitive anoderm. This study was carried out to evaluate the clinical outcome of stapled hemorrhoidopexy at The Aga Khan University Hospital.

Materials and Methods:

A sample of 140 patients with symptomatic second-, third-, and fourth-degree hemorrhoids and circumferential mucosal prolapse underwent stapled hemorrhoidopexy from July 2002 to July 2007. They were evaluated for postoperative morbidity, analgesic requirement, and recurrence.

Results:

Seventy-eight percent were males and the mean age was 45 (range 16-90) years. The mean operative time was 35 (15-78) min. The mean parenteral analgesic doses during the first 24 h were 2.1. All patients received oral analgesics alone after 24 h. No significant postoperative morbidity was observed. The mean in-patient hospital stay was 1.3 (0-5) days. Patients were followed-up for 24 (range, 2-48) months. Minor local recurrence of hemorrhoids was seen in four patients and was managed by band ligation.

Conclusion:

Stapled hemorrhoidopexy procedure was found safe, well tolerated by patients with minimal parenteral analgesic use and early discharge from the hospital.     

Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease

Purpose  The pathogenesis of hemorrhoidal disease is based mainly on the vascular hyperplasia theory. The aim of this study was to reassess the morphology and the functional mechanisms of the anorectal vascular plexus with regard to hemorrhoidal disease. Materials and methods  The anorectal vascular plexus was investigated in 17 anorectal and five hemorrhoidectomy specimens by means of conventional histology and immunohistochemistry. Vascular corrosion casts from two fresh rectal specimens were used for scanning electron microscopy. Transperineal color Doppler ultrasound (CDUS) with spectral wave analysis (SWA) was performed in 38 patients with hemorrhoidal disease and 20 healthy volunteers. Results  The anorectal vascular plexus was characterized by a network of submucosal vessels exhibiting multiple thickened venous vessels separated by distinct sphincter-like constrictions. CDUS and SWA showed significant flow differences in peak velocities (6.8 ± 1.3 cm/s vs. 10.7 ± 1.5 cm/s; P = 0.026) and acceleration velocities (51 ± 4 ms vs. 94 ± 11 ms; P = 0.001) of afferent vessels between the control group and patients with hemorrhoidal disease. Conclusions  Coordinated filling and drainage of the anorectal vascular plexus is regulated by intrinsic vascular sphincter mechanisms. Both morphological and functional failure of this vascular system may contribute to the development of hemorrhoidal disease.     

First 100 Cases With Doppler-Guided Hemorrhoidal Artery Ligation

Purpose This study was designed to examine the benefits of a Doppler-guided hemorrhoidal artery ligation technique in terms of surgical outcome, functional recovery, and postoperative pain. Methods Using local, regional, or general anesthesia, 100 patients with symptomatic Grades II or III hemorrhoids underwent sonographic identification and suture ligation of six to eight terminal branches of the superior rectal artery above the dentate line. Visual Analog Scales were used for postoperative pain scoring. Surgical and functional outcomes were assessed at 6 weeks and 3, 6, and 12 months after surgery. Results There were 42 (42 percent) males and 58 (58 percent) females (mean age, 42 years; median duration of symptoms, 6.3 years). The mean operative time was 19 minutes. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only five were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative course. The mean pain score decreased from 2.1 at two hours postoperative to 1.3 on the first postoperative day. All patients had a complete functional recovery by the third postoperative day. Ninety-four patients remained asymptomatic after a mean follow-up of six months: four patients required additional surgical excision, and two required rubber band ligations for persistent bleeding. On follow-up, there was no report of incontinence to gas or feces, fecal impaction, or persistent pain. Conclusions Our experience indicates that Doppler-guided hemorrhoidal artery ligation is safe and effective and can be performed as an outpatient procedure with local or regional anesthesia and with minimal postoperative pain and early recovery. Reprints are not available.     

Stapled hemorrhoidopexy – Initial experience from a general surgery center

Background

Stapled hemorrhoidopexy is gaining popularity as a relatively painless alternative to conventional excisional hemorrhoidectomy. The initial experience from a service hospital is presented along with review of literature.

Methods

40 cases were managed by stapled hemorrhoidopexy (SH) over a period of two and half years. The primary outcome measures assessed were the analgesic requirement in the post-operative period and the time taken to resume Activities of Daily Living (ADL). Additional outcome measures studied were; presence of bleeding per rectum, prolapse of mass per rectum, incontinence to flatus/stool, post-operative urinary retention, requirement of a repeat procedure, presence of post-operative anal stenosis, and residual external haemorrhoids at 1 week, 1, 3 and 6 months and 1 year after surgery.

Results

40 patients with grade II, III and IV hemorrhoids underwent SH under spinal anesthesia. In the first 24 h 17 patients required a single dose of Injection Diclofenac Sodium while 19 patients required two doses and 4 patients had to be given three doses. 14 patients (35%) achieved Katz Index of Independence in Activities of Daily Living score of 6 on the first post-operative day and another 17 (42.5%) on the second post-operative day. By the fourth post-operative day all patients had achieved a score of 6. One patient had a rectal perforation as a complication of the procedure and another required a second procedure for excision of thrombosed external hemorrhoids.

Conclusion

Stapled hemorrhoidopexy is associated with less post-operative pain and early resumption of ADL. Although the procedure appears simple to perform, it can be associated with serious complications and still cannot be considered the standard of care for the operative treatment of internal hemorrhoids.     

吻合器痔上黏膜环切术与外剥内扎术治疗重度痔疮的远期疗效对比观察

目的：对比吻合器痔上黏膜环切术（PPH）与外剥内扎术远期疗效。方法：将2005年1月-2006年12月重度痔病患者分为两组,治疗组行PPH术,对照组行传统手术,对远期疗效进行对比分析。结果：两组60个月观察数据中并发症之一“肛门坠胀或急便感”发生率对比差异有统计学意义（P<0.05）,其他观察指标包括复发率、总的并发症发生率、患者满意度对比差异均无统计学意义（P>0.05）。结论：PPH治疗重度痔疮远期并发症中“肛门坠胀”发生率较外剥内扎术高,其余远期疗效差异不大。     

吻合器痔上粘膜环切术的护理配合

为探讨吻合器痔上黏膜环切术（Procedure for Prolapse and Hemorrhoids,PPH）的护理配合经验,文章对医院2009年4月至2011年7月间施行的86例PPH术的护理配合进行分析和总结,包括术前对患者的心理护理和手术物品准备,术中巡回护士和器械护士应做的护理配合等,认为术前对患者充分的沟通交流,术中正确的体位摆放、严密的病情观察、及时准确的操作配合,是手术安全、顺利进行,避免并发症发生的重要保证。