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외래 환자에서 Bipolar Diathermy를 이용한 치핵내 응고술에 대한 효과

New Technique for Treatment of Hemorrhoids by Using Bipolar Hemo-Coagulation(BHC)

대한대장항문학회지 1997년 13권 2호 p.229 ~ 237
유정준 ( Yoo Jung-Jun ) - 송도병원 외과

이철호 ( Lee Chul-Ho ) - 송도병원 외과
이광렬 ( Lee Kwang-Ryul ) - 송도병원 외과
박세영 ( Park Se-Young ) - 송도병원 외과
임석원 ( Lim Seok-Won ) - 송도병원 외과
김현식 ( Kim Hyun-Sik ) - 송도병원 외과
이종균 ( Lee Jong-Kyun ) - 송도병원 외과

Abstract


Hemorrhoids are the most common problem in anorectal disease, presenting bleeding and prolapse. The definitive treatmant for severe hemorrhoids is surgery, but for milder cases, it is difficult to recommend a hemonhoidectomy. Some patients, especially relatively young and active males, don’t want to be admitted, and they ask for ambulatory surgery. For that reason, we have developed a modified bipolar probe which can be simply and conveniently applied and which produces as good a result as that produced by a radical hemouhoidectomy. We restrospectively analyzed the cases of 341 patients who had received a BHC(bipolar homo-coagulation) between July 1994 and December 1995 and who had been followed up for at least six months. The results are as follows: 1) 309 cases(90.6%) were Grade II, and 32 cases(9.4%) were Grade III hemorrhoids. The chief complaint was bleeding in 179 cases(52.5%) and prolapse in 148 cases(43.4%). 2) Evaluation of the BHC procedure was based on patient satisfaction. About threefourths of the patients were very satisfied, and 59 patients(17.3%) were somewhat satisfied. Grade III patients were relatively more satisfied than others, regardless of the number of piles managed by BHC, and patients whose symptom was bleeding were significantly more satisfied, in general, than those with prolapse. Only 26 patients(7.6%) were dissatisfied. 3) No postoperative discomfort was observed in 153 cases(44.9%). However, post-operalive pain and bleeding were present in 92 and 50 cases, respectively. 4) Complications were observed in a total of 26 cases(7.6%). Skin tags were the most frequently observed complication(13 cases), followed by secondary bleeding which was managed by sutures(6 cases). 5) Three patients experienced recurrent hemorrhoids. Two were treated by using a radical hemorrhoidectomy, and one by using a second BHC. Based on these five results, we consider BHC to be a very useful technique for treating Grade II and early Grade III hemorrhoids by outpatient surgery and to be a time-saving procedure for treating accessory piles after main pile extirpation. Furthermore, early detection of hemorrhoids along with their early management by BHC will reduce the need for more radical surgery at some later time.

키워드

Hemorrhoids
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