Stapled hemorrhoidopexy and milligan morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: Long-term evaluation and clinical results
Stapled hemorrhoidopexy and milligan morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: Long-term evaluation and clinical results
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DOI：
10.1007/s10350-007-0294-6
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发表时间：
2007-11-01
影响因子：
3.9
通讯作者：
Sermoneta, Daniel
中科院分区：
文献类型：
--
作者：
Mattana, Claudio;Coco, Claudio;Sermoneta, Daniel
目的：方法：回顾性分析100例四度痔患者行Milligan Morgan术式或吻合器痔上黏膜环切术的临床资料。所有患者进行了访问，并提交了一份调查问卷，以评估恢复症状，功能的结果，和复发率。结果：平均随访时间为54个月的吻合器痔固定术和92个月的Milligan-Morgan程序。Milligan-Morgan手术的术后疼痛和恢复正常活动更差（视觉模拟量表8.56 vs. 5.46，P < 0.001; 2.4 vs. 2周，P值=0.018）。8%的吻合器痔固定术患者抱怨自发性疼痛或排便时疼痛，而接受Milligan-Morgan手术的患者为0%。我们注意到，吻合器痔固定术的出血率为14%，而Milligan-Morgan手术为0%（P < 0.006），内急后重为32%，而Milligan-Morgan手术为0%（P < 0.001），吻合器痔固定术的瘙痒率为4%，而Milligan-Morgan手术为0%。两组的轻微渗漏相似。在Milligan-Morgan中，胃肠胀气控制受损的发生率较低。吻合器痔固定术与Milligan-Morgan手术相比复发的相对风险为1.18（95%置信区间1 <相对风险< 1.4）。术后患者满意度无统计学差异。结论：长期随访似乎表明，在症状恢复和复发风险方面，Milligan-Morgan手术的结果更有利。
Purpose: The long-term results after stapled hemorrhoidopexy compared with Milligan-Morgan procedure are discussed.Methods: The clinical data of 100 patients treated by Milligan-Morgan procedure or stapled hemorrhoidopexy for fourth-degree hemorrhoids have been reviewed. All patients were visited and submitted to a questionnaire to evaluate resumption of symptoms, functional results, and recurrence rate.Results: The mean follow-up was 54 months for stapled hemorrhoidopexy and 92 months for the Milligan-Morgan procedure. Postoperative pain and return to normal activity were worse in the Milligan-Morgan procedure (Visual Analog Scale 8.56 vs. 5.46, P < 0.001; and 2.4 vs. 2 weeks, P value=0.018). Eight percent of patients who had stapled hemorrhoidopexy complained of spontaneous pain or pain during defecation vs. 0 percent of patients who underwent the Milligan-Morgan procedure. We noted that there was bleeding in 14 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P < 0.006), tenesmus in 32 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P < 0.001), and pruritus in 4 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure. Minor leakage was similar in the two groups. Flatus impaired control was less frequent in Milligan-Morgan. The relative risk of recurrence for stapled hemorrhoidopexy compared with Milligan-Morgan procedure was 1.18 (95 percent confidence interval 1 < relative risk < 1.4). No statistical difference was noted in patients' satisfaction after the procedures.Conclusions: Long follow-up seems to indicate more favorable results in Milligan-Morgan procedure in terms of resumption of symptoms and risk of recurrence.