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거상고정식 점막하 치핵절제술

Lift-up Submucosal Hemorrhoidectomy

대한대장항문학회지 2005년 21권 3호 p.145 ~ 151
양형규 ( Yang Hyung-Kyu ) - 양병원 대장항문과

임청호 ( Lim Chung-Ho ) - 중동병원 외과
신현근 ( Shin Hyeon-Keun ) - 양병원 대장항문과
강충훈 ( Kang Chung-Hoon ) - 양병원 대장항문과
정승규 ( Jung Seung-Kyu ) - 양병원 대장항문과
최재표 ( Choi Jae-Pyo ) - 양병원 대장항문과

Abstract


Purpose: Hemorrhoidal tissues are normal anatomic structures present in every individual, and they act as cushions and are anchored to the internal anal sphincter by a connective tissue system. When the anchoring connective tissues undergo bears degenerative changes, the hemorrhoids not only bulge but also descend into the lumen of the anal canal. The veins also become distended. The previous hemorrhoidectomy methods (excision and ligation methods) tend to remove excessive amounts of hemorrhoidal tissues, possibly causing incontinence or stenosis. This study introduces a modified hemorrhoidectomy method.

Methods: A retrospective study was done with 650 patients (358 males, 292 females) who underwent hemorroidectomies from Jan. 1997 to Jan. 2000. Under saddle-block anesthesia, the patient was placed in a prone jack-knife position. After narrow incisions on the mucosa of the selected pile, a bilateral submucosal dissection was performed. The pedicle was ligated by transfixing sutures 2 or 3 times with 2-0 chromic catgut to lift up the mucosa.

Results: The mean operation time per hemorrhoidal pile was 12.7 minutes, and the mean hospital-stay was 4.3 days. Acute and delayed postoperative anal bleeding occurred in 7 (1.1%) and 3 (0.5%) patients, respectively. The symptoms of both subsided spontaneously. Ninety-three (93) patients (14.3%) reguired nelaton catheterization for voiding difficulty, and one patient (0.2%) showed mild anal stenosis. The most frequent complaint was skin-tag formation (148 cases, 22.8%). In 140 cases, the skin tag was removed under local anesthesia.

Conclusions: It is desirable to keep the normal structure of the anal canal by removing as little of the cushions as possible. Our ´lift-up submucosal hemorrhoidectomy´ shows good results and is an easy operative method when compared with Parks’ original method. J Korean Soc Coloproctol 2005; 21:145-151

키워드

거상고정식 점막하 치핵절제술;항문쿠션
Lift-up submucosal hemorrhoidectomy;Anal cushion
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