PPH结合痔切除与开放式外剥内扎术治疗环状混合痔的对比研究

目的：比较PPH结合痔切除与传统式手术治疗环状混合痔的临床效果。方法：对100例PPH手术与传统式手术组的结果进行分析比较。结果：通过对手术时间、疼痛指数、住院时间、恢复工作时间、患者的满意度、术后各种并发症的发生率及复发等进行比较研究，PPH组占有明显优势。结论：PPH结合痔切除术操作简单、安全可靠、出血少、疼痛轻、并发症少、恢复快，是治疗环状混合痔的首选术式。     

Radiofrequency haemorrhoid surgery: An alternative to newer treatment of haemorrhoids

Background: The author describes his experience of treatment of advanced haemorrhoidal disease using a technique called radiofrequency ablation and plication of haemorrhoids. Patients and Methods: Both male and female patients presenting with prolapsing haemorrhoids with indications for surgery were enrolled for the study. An Ellman radiofrequency generator was used for ablation of haemorrhoids. The surgical technique and clinical follow up of patients operated by this technique is presented. Patients were initially called at 7, 14 and 30 postoperative days and then at least 2 years after the procedure. Results in terms of mean hospital stay, postoperative pain, postoperative complications, period of incapacity for work and effectiveness of the procedure are presented. Results: 1260 patients operated with this technique were assessed. The average duration of operation was 7 min (range 5–9 min). Mean hospital stay was 11 h (range 6–23 h). The immediate postoperative complication included secondary bleeding, retention of urine and perianal thrombosis. The mean period of incapacity for work was 8 days (range 6–14 days). The mean analgesic requirement was 20 tablets of Tramadol (range 14–33). At the last follow up, 2% of patients had recurrence of bleeding and 6% developed anal skin tags. Conclusion: The procedure of radiofrequency ablation and plication of haemorrhoids shows promising results in patients with advanced haemorrhoidal disease. Being safe, effective, and a swift technique, it can be proposed as an alternative to conventional surgical procedures.     

The prevalence of proctological symptoms amongst patients who see general practitioners in France

Background: Patients do not often discuss anal symptoms, resulting in late diagnosis of proctological disorders and impacting health. Poor epidemiological knowledge is a contributing factor to this, which can be a significant problem in general medicine. Authors evaluated the role of family doctors in proctological disorders by assessing how many of these are spontaneously diagnosed and how many are diagnosed after questioning the patient.

Methods: Thirty-nine general practitioners completed a targeted questionnaire to assess all patients seen prospectively over 2.5 days of consultations.

Results: A total of 1079 questionnaires were completed, 621 (58%) for females and 458 (42%) for males with a median age of 54. Twenty-two patients (2%) were seen primarily for anal symptoms. Following questioning, an anal symptom was found in 153 patients (14%). Symptoms reported were: bleeding (32%), pain (31%), pruritus ani (22%), swelling (22%), oozing (14%), and anal discharge (14%). Physicians’ diagnoses were: haemorrhoids, anal fissure, anal discharge, dermatology disease, and functional disorder. In 35% of patients, questioning alone was used to make these diagnoses. Anal incontinence was the only factor associated with referral to a specialist (OR = 5; 95% CI: 1.4–17.8).

Conclusion: The role of proctology in the general population appears to be significant. In five out of six cases, patients conceal anal symptoms. The high proportion of unexamined patients with anal symptoms is probably multifactorial. Further studies are needed to identify these and put in place the improvement of diagnosis and treatment of anal disorder.     

Safety and short‐term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial

Aim Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan–Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects. Method In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded. Results The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75± 17.51 vs 28.05 ± 10.23 cm², P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0–2, vs 2–5, P < 0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients. Conclusion Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse.     

Fissurectomy with posterior midline sphincterotomy and anoplasty (FPSA) in the management of chronic anal fissures

Although lateral internal sphincterotomy is widely accepted as the treatment of choice for anal fissures, we report our experience of successfully treating 195 consecutive patients with posterior chronic anal fissures by performing fissurectomy with midline sphincterotomy and anoplasty (FPSA). The surgical technique is described and its indications and results are briefly discussed.     

痔上粘膜环切钉合术治疗Ⅳ度内痔术后对排便功能的影响

目的评价痔上粘膜环切钉合术术后对排便功能的影响.方法将52例实施痔上粘膜环切钉合术(PPH手术)的术后疼痛评分、早期并发症及随访一年后的结果进行分析.结果PPH组术后疼痛明显减轻,恢复快;一年随访PPH术后痔脱垂13例、肛门瘙痒12例、肛周皮赘20例、里急后重12例,促便感3例,排便困难1例,直肠炎2例,无疼痛及肛门狭窄及失禁.结论对于Ⅳ度内痔,PPH手术目前仍有需要探讨的地方,对于脱垂及肛周皮赘明显者必须附加有限度的痔切除术或皮赘切除才能有效地缓解症状,同时要告知患者可能出现的对排便功能的影响.     

Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception

Aim Treatment of haemorrhoidal prolapse by stapled haemorrhoidopexy (SH) and obstructed defaecation syndrome with the stapled transanal rectal resection (STARR) technique is becoming increasingly popular with patients and surgeons. Unfortunately, serious complications have been identified. The aim of the present study was to analyse the complications and their treatment to see where they might be avoided and to determine best management. Method All Units of Coloproctology belonging to the Italian Unitary Society of Coloproctology (SIUCP) were asked to return documentation of serious complications following SH and STARR. Results Forty‐six reports were received from 23 centres. Twenty‐seven serious complications were reported. Twenty occurred after SH (13 PPH 03, 7 PPH 01) (Endo‐surgery Inc., Cincinnati, Ohio, USA) and seven after STARR. Complications were treated by abdominal operation in nine patients [colostomy (3), ileostomy (2), Hartmann’s resection (1) and anterior resection (1)]. Conclusion Stapled haemorrhoidopexy and STARR can result in serious complications requiring major surgery for their treatment.