자동문합기를 이용한 치핵절제술의 유용성: 초음파 가위를 이용한 치핵절제술 및 전기 소작기를 이용한 Milligan식 치핵절제술과의 비교
Benefits of Stapled Hemorrhoidectomy Compared with Ultrasonic Dissector and Milligan’s Hemorrhoidectomy
서형민, 박철운, 이길연, 윤충, 이기형,
소속 상세정보
서형민 ( Seo Hyung-Min )
경희대학교 의과대학 외과학교실
박철운 ( Park Chul-Woon )
경희대학교 의과대학 외과학교실
이길연 ( Lee Kil-Yeon )
경희대학교 의과대학 외과학교실
윤충 ( Yoon Choong )
경희대학교 의과대학 외과학교실
이기형 ( Lee Kee-Hyung )
경희대학교 의과대학 외과학교실
KMID : 0356720020180030172
Abstract
Purpose: Surgical hemorrhoidectomy has a reputation for being a painful procedure. Many surgical methods have been devised for reducing posthemorrhoidectomy pain. Nevertheless, the result are unsatisfactory. Stapled hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared among three hemorrhoidectomy methods.
Methods: A total of 150 consecutive patients with 3rd and 4th degree of prolapsed hemorrhoids underwent hemorrhoidectomy with stapler group (n=50) or hemorrhoidectomy with ultrasonic dissector group (n=50) or Milligan’s hemorrhoidectomy using by diathermy (n=50) (by same surgeon between January and September 2001). We evaluated the difference among three techniques in operative time, postoperative pain, and patient satisfaction (using visual analogue scale).
Results: Mean operative time for hemorrhoidectomy with ultrasonic dissector was 19 minute; for stapler group, it was 18 minute; for Milligan’s group, it was 23.6 minute (P＜0.05). There was significant difference in operative time between stapler and Milligan’s group. There were significant difference in pain measurement reported on immediate (5.8 for stapler, 7.2 for ultrasonic dissector, and 9.2 for Milligan’s group, P＜0.01), day 1 (4.3, 5.5, and 6.8, P＜0.01), day 2 (3.7, 4.7, and 6, P＜0.01), day 3 (3.0, 3.6, and 4.6, P＜0.01), day 4 (3.1, 3.5, and 4.6, P＜0.01), day 5 (2.5, 3.4, and 4.6, P＜0.01), day 6 (2.0, 3.2, and 4.3, P＜0.01), day 7 (1.8, 3, and 4.2, P＜0.01), and defecation (4.0, 7.0, and 8.9, P＜0.01). The mean
analgesic (piroxicam 20 ㎎) requirement was 0.3 times for stapler, 1.9 for Ultrasonic dissector, and 3.1 for Milligan’s group (P＜0.01). Mean hospital stay was 1.6 days for stapler, 1.7 for ultrasonic dissector, 2.8 for Milligan’s group (P＜0.01). Patient satisfaction on day 7 was 8.2 for stapler, 6.2 for ultrasonic dissector, and 5.2 for Milligan’s group (P＜0.01). There was no difference in catheterization for urinary retention. It is probably due to spinal anesthesia.
Conclusions: The study demonstrates significantly reduced postoperative pain and shorter hospital day after stapled hemorrhoidectomy compared among three groups. This resulted in an earlier return to working activities for stapled
technique.
키워드
자동문합기 치핵절제술;초음파 가위 치핵절제술;Milligan식 치핵절제술
Stapled hemorrhoidectomy;Ultrasonic hemorrhoidectomy;Milligan’s hemorroidectomy
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