내괄약근 부분절개술을 병행한 치핵절제술시 수술전후의 항문압의 비교
Anal Pressures in Hemorrhoids and Posthemorrhoidectomy With Lateral Internal Sphincterotomy
소속 상세정보
신명준/Myeong Jun shin,
윤성수/김상운/김재황/허영수/심민철/권굉보/Sung Su Yun/Sang Woon Kim/Jae Hwang Kim/Young Soo Huh/Min Chul Shim/Koing Bo Kwun
KMID : 0356719910070020135
Abstract
치핵환자는 Haycock과 Smith 및 Arabi등에 의하면 정상인보다 항문압이 높고 치핵절제
술시 괄약근 수지확장법이나 내괄약근 부분절개술을 병행하는 것이 효과적이며 이학적검사
로 측정한 항문압은 실제 측정한 항문압과 차이가 있어 부정확하다고 하였다. 또한 국내에
서는 치핵환자에서 수술전과 내괄약근 부분절개술후 항문압을 측정한 예가 없고 한국인의
정상항문압과 치핵환자의 항문압에 대한 보고가 미비하여 치핵군, 주사요법군, 수술군, 대조
군에서 항문압을 측정하여 다음과 같은 결과를 얻었다.
1) 치핵환자의 휴식항문압(91±23 mmHg)은 대조군의 휴식항문압(63±16 mmHg)보다 유
의하게 높았다(p<0.001).
2) 치핵환자의 수축항문압(137±32 mmHg)은 대조군이 수축항문압(98±28 mmHg)보다
유의하게 높았다(P< 0.001).
3) 주사요법군의 휴식항문압(72±17 mmHg) 및 수축항문압(125±68 mmHg)은 대조군과
유의한 차이가 없었다.
4) 수술군의 휴식항문압(51±13 mmHg)은 대조군에 비해 유의하게 감소되었으나(p<0.01)
수축항문압 (97±26 mmHg)은 대조군과 유의한 차이가 없었다.
이상의 결과로써 치핵환자에서는 비정상적으로 항문압이 증가되어 있고 이는 항문내괄약
근 기능항진에 의한 것으로 술전 항문압이 증가된 치핵환자에서 치핵절제술시 내괄약근 부
분절개술을 병행하는 것이 이론적으로 타당하다는 것을 알 수 있다.
#초록#
Patients with hemorrhoid and anal fissure are considered to have
significantly
associated resting anal pressures than controls. These findings are used to support the
argument that operations such as manual dilatation of the anus and lateral internal
sphincterotomy will correct the primary abnormality and achieve long term pressure
reduction in anal canal. By selecting patients with high Pressure we hoped to define
those patients likely to benefit from manual dilatation of the anus and lateral internal
sphincterotomy.
Resting anal Pressure and voluntary maximal anal contraction pressure were stuied in
26 patients(23 male, 3 female) with hemorrhoid who have no previous treatment, in 10
patients(8 male, 2 female) with hemorrhoid who have previous injection therapy history,
in 13 patients(7 male, 6 female) who have had hemorrhoidectomy with lateral internal
sphincterectomy 3 months ago and 19(all male) asymptomatic control subjects in whom
the anal canal was considered normal on proctoscopy.
Pressure recordings were taken after proctoscopy in both patients and volunteer
controls. With the patient in the left lateral decubitus position both resting anal pressure
and maximum voluntary anal contraction pressure were recorded 10 cm from anal verge
using a water filled polyethylene catheter connected to a pressure measurement
transducer and a recording device, then the catheter was pulled a constant rate with a
mechanical pulling device.
The results were as follows:
1) The mean resting anal pressure in Patients with hemorrhoid, who halve no
Previous, treatment, (91±23 mmHg) was very significantly higher than that of the
control subjects(62±15 mmHg)(p< 0.001).
2) The mean maximum voluntary anal contraction pressure in patient with hemorrhoid,
who have no previous treatment, (136±32 mmHg) was very significantly higher than
that of the control subjects(98±28 mmHg)(p< 0.001).
3) The mean resting anal pressure(72±17 mmHg) and mean maximum voluntary anal
contraction Pressure(125±68 mmHg ) in patient with hemorrhoid with previous injection
therapy were not significantly different than those of control subjects.
4) The mean resting anal pressure in patient with previous hemorrhoidectomy and
lateral sphincterotomy (51±13 mmHg) was significantly lower than that of the control
subjects(P<0.01). But the mean maximum voluntary anal contraction Pressure(97±26
mmHg) was not significantly different than that of the control subjects.
The results suggested that it is nessary to measure anal pressure in patients with
hemorrhoid for the treatment and evaluation of therapeutic effect. And inappropriate
injection therapy should be avoided to prevent anal sphincter injury and anal stenosis.
The patients who had hemorrhoidectomy and lateral internal sphincterotomy revealed a
very significantly decreased resting anal pressure without incontinence and we could
measure an intact voluntary anal contraction pressure.
키워드
Anal Pressure; Anal Sphincter; Hemorrhoids;
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