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원형자동봉합기 치핵절제술의 임상적 분석

Clinical Study of Circular Stapler Hemorrhoidectomy

대한대장항문학회지 2005년 21권 6호 p.370 ~ 375
강중구 ( Kang Jung-Gu ) - 국민건강보험공단 일산병원 외과학교실

이석영 ( Lee Seok-Young ) - 국민건강보험공단 일산병원 외과
이상혁 ( Lee Sang-Hyuk ) - 국민건강보험공단 일산병원 외과

Abstract


Purpose: A circular stapler hemorrhoidectomy is widely used to treat hemorrhoids and has the advantages of less pain and an earlier return to work compared with a conventional excisional hemorrhoidectomy. This study examined the clinical significance and efficacy of a circular stapled hemorrhoidectomy.

Methods: One hundred eighty-six (186) patients with prolapsed hemorrhoids underwent surgery using a circular stapler. The patients’ characteristics, the operation time, the postoperative course, the procedure- related factors, the pain, and the complications were analyzed. All the patients received a follow-up examination at the outpatient clinic, including the time to return to work, and the degree of satisfaction was analyzed.

Results: Grade-III hemorrhoids were the most common complaint (74.1%), followed by grade-IV hemorrhoids (23.7%). Twenty-one cases (11.3%) had undergone previous anal operations: hemorrhoids, fissure, and fistula. Regarding the anesthetic method, caudal anesthesia was used in 59.7% of the cases, and spinal or saddle anesthesia was used in 39.2%. The mean operation time was 19.1 minutes (range: 8∼50). The postoperative pain scores were 3.4 on the operation day, 2.1 on the postoperative 3rd day, and 0.9 on the postoperative 7th day. During the operation, a hemostatic suture was made at the suture line in 72.0% of the cases. Muscle involvement was detected at a donut specimen grossly in 9% of cases and microscopically in 48.9%. The mean thickness of muscle involvement was 2.5 mm. In the postoperative course, the time for the first bowel movement was 1.2 days, and the mean hospital stay was 2.1 days. The mean time needed for the patient to return to work was 6.2 days. The most common complication encountered was urinary problems (34.9%). The incidence of postoperative bleeding was 2.2%. Postoperative follow- up revealed one case of a hemorrhoids recurrence and one case of temporary fecal incontinence.

Conclusions: The circular stapler hemorrhoidectomy has no disadvantage in terms of operation time and operative course, and has an advantage in terms of operative pain and an earlier return to normal work without any significant or serious complications. Moreover, it has minimal long-term complications. Therefore, a circular stapler hemorrhoidectomy can be performed safely and is recommended as a useful method for treating hemorrhoids. J Korean Soc Coloproctol 2005; 21:370-375

키워드

치핵;원형자동봉합기 치핵절제술
Hemorhhoids;Circular stapler hemorrhoidectomy
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