ﮔﺰارش ﻧﺘﺎﻳﺞ ﻫﻤﻮروﺋﻴﺪوﭘﻜﺴﻲ ﺑﺎ اﺳﺘﺎﭘﻠـﺮ در 47 ﻣﻮرد ﻫﻤﻮروﺋﻴﺪﻫﺎي ﭘﺮوﻻﺑﻪ ﻋﻼﻣﺖ دار

Report of Hemorrhoidopexy with Stapler in 47 Patients with Prolapsed Hemorrhoid

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻋﻠﻴـﺮﻏﻢ ﺍﺭﺍﺋﻪ ﺭﻭﺵ ﻫﺎﻱ ﺩﺭﻣـﺎﻧﻲ ﻣﺘﻨـﻮﻉ ﺩﺭ ﺑﺮﺧـﻮﺭﺩ ﺑﺎ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﻋﻼﻣـﺖ ﺩﺍﺭ، ﻫﻨﻮﺯ ﻣـﻮﻓﻖ ﺗﺮﻳﻦ ﺭﺍﻩ ﺩﺭﻣـﺎﻥ ﺁﻥ، ﺭﻭﺵ ﺟـﺮﺍﺣﻲ ﺍﺳﺖ. ﻭﺟـﻮﺩ ﻣﺴﺎﺋﻠﻲ ﺍﺯ ﻗﺒﻴـﻞ ﺩﺭﺩ ﺷـﺪﻳﺪ ﺑﻌـﺪ ﺍﺯ ﻋﻤﻞ، ﺍﺧﺘﻼﻻﺕ ﺩﻓـﻊ ﻭ ﻃـﻮﻻﻧﻲ ﺑﻮﺩﻥ ﻧﺴﺒﻲ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻭ ﺩﻭﺭﺓ ﻧﻘﺎﻫـﺖ ﺑﻌـﺪ ﺍﺯ ﺁﻥ، ﻣﺤﻘﻘـﺎﻥ ﺭﺍ ﺑـﺮ ﺁﻥ ﺩﺍﺷﺖ ﻛـﻪ ﺑﻪ ﺩﻧﺒﺎﻝ ﺭﻭﺷﻲ ﺟﺎﻳﮕـﺰﻳﻦ ﺭﻭﺵ ﻣـﺮﺳﻮﻡ ﻣـﻮﻟﻴﮕﺎﻥ ـ ﻣـﻮﺭﮔﺎﻥ ﺑﺎﺷﻨﺪ. ﻣﻄﺎﻟﻌـﺔ ﺣﺎﺿـﺮ ﺑـﺮﺭﺳﻲ ﻧﺘـﺎﻳﺞ ﺗﺠـﺮﺑﻴﺎﺕ ﻣـﺎ ﺩﺭ ﻋﻤـﻞ ﻫﻤـﻮﺭﻭﺋﻴﺪﻭﭘﻜﺴﻲ ﺑﺎ ﺍﺳﺘﺎﭘﻠـﺮ ﺍﺳﺖ ﻛـﻪ ﺑﻪ ﻋﻨـﻮﺍﻥ ﻳﻜﻲ ﺍﺯ ﺍﻳﻦ ﺭﻭﺵ ﻫﺎ ﻣﻄـﺮﺡ ﺷﺪﻩ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﺯ ﺳﺎﻝ 1378 ﺗﺎ 1385، 47 ﺑﻴﻤﺎﺭ 31 ﻣﺮﺩ ﻭ 16 ﺯﻥ( ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ 53 ﺳﺎﻝ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺁﺭﺍﺩ ﺗﻬﺮﺍﻥ ﺗﺤﺖ ﻋﻤﻞ ﻫﻤـﻮﺭﻭﺋﻴﺪﻭﭘﻜﺴﻲ ﺑﺎ ﺍﺳﺘﺎﭘﻠـﺮ ﻗـﺮﺍﺭ ﮔـﺮﻓﺘﻨﺪ. ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺣﺪﺍﻗﻞ ﻳﻚ ﺑﺎﺭ، 6 ﻣﺎﻩ ﺑﻌـﺪ ﺍﺯ ﻋﻤﻞ ﻣﻌﺎﻳﻨﻪ ﺷﺪﻧﺪ. ﺗﻌﺪﺍﺩ 11 ﺑﻴﻤﺎﺭ ﻫﻤﻮﺭﻭﺋﻴﺪ ﺩﺭﺟﺔ 2 )23/4%(، 30 ﺑﻴﻤﺎﺭ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺭﺟﺔ 3 )63/9%(، 5 ﺑﻴﻤﺎﺭ ﻫﻤﻮﺭﻭﺋﻴﺪ ﺩﺭﺟﺔ 4 )10/6 ﻭ ﻳﻚ ﺑﻴﻤﺎﺭ ﭘﺮﻭﻻﭘﺲ )2/1 ﺩﺍﺷﺘﻨﺪ. ﻣﻴﺎﻧﮕﻴﻦ ﺯﻣﺎﻥ ﭘﻴﮕﻴـﺮﻱ 30 ﻣﺎﻩ ﺑﻮﺩ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴـﻦ ﺯﻣﺎﻥ ﻋﻤـﻞ ﺟـﺮﺍﺣﻲ 38 ﺩﻗﻴـﻘﻪ30 ﺗﺎ 60 ﺩﻗﻴﻘﻪ( ﻭ ﻣﺘـﻮﺳﻂ ﺯﻣﺎﻥ ﺍﻗﺎﻣـﺖ ﺩﺭ ﺑﻴﻤـﺎﺭﺳﺘﺎﻥ 1/3 ﺭﻭﺯ )1 ﺗﺎ 3 ﺭﻭﺯ( ﺑﻮﺩ. ﻫﻨﮕﺎﻡ ﻋﻤﻞ، ﻋﺎﺭﺿﻪ ﺍﻱ ﺭﺥ ﻧﺪﺍﺩ. ﭘﺲ ﺍﺯ ﻋﻤﻞ، ﻣﻴـﺰﺍﻥ ﻣـﻮﻓﻘﻴﺖ ﺩﺭ ﻣﺠﻤـﻮﻉ 40 ﻣـﻮﺭﺩ 85/1 ﺑـﻮﺩ ﻭ 4 ﻣـﻮﺭﺩ )8/5 ﻋـﻮﺍﺭﺽ ﺑﻌـﺪ ﺍﺯ ﻋﻤﻞ ﺩﺍﺷﺘﻨﺪ. ﻣـﻮﺭﺩ ﺍﻭﻝ ﺑﻴﻤـﺎﺭﻱ ﺑـﻮﺩ ﻛـﻪ ﺩﺭ ﻓﺎﺻﻠﺔ 48 ﺳﺎﻋـﺖ ﭘﺲ ﺍﺯ ﻋﻤـﻞ ﺩﭼـﺎﺭ ﺧـﻮﻧﺮﻳﺰﻱ ﺷﺪ ﻭ ﺑﺎ ﺑﺴﺘـﺮﻱ ﻣﺠـﺪﺩ ﺗﺤﺖ ﺑـﺮﺭﺳﻲ ﻗـﺮﺍﺭ ﮔـﺮﻓﺖ ﻭ ﭼـﻮﻥ ﻳﺎﻓﺘﺔ ﭘﺎﺗﻮﻟـﻮﮊﻳﻚ ﻧﺪﺍﺷـﺖ ﺑﺎ ﺩﺭﻳﺎﻓـﺖ 2 ﻭﺍﺣـﺪ ﺧـﻮﻥ ﻣـﺮﺧﺺ ﺷﺪ. ﺗﻌﺪﺍﺩ 2 ﺑﻴﻤﺎﺭ ﭘﺮﻭﻻﭘﺲ ﻣﺠﺪﺩ ﻫﻤﻮﺭﻭﺋﻴﺪ ﺩﺍﺷﺘﻨﺪ ﻛﻪ ﺍﻭﻟﻲ ﺑﺎ ﺗـﺰﺭﻳﻖ ﺍﺳﻜﻠـﺮﻭﺯﺍﻥ ﻭ ﺩﻭﻣـﻲ ﺑﺎ ﺑﺮﺩﺍﺷـﺘﻦ ﭘﺎﻛـﻪ )(Pocket ﺑﺎ ﺑﻲ ﺣﺴﻲ ﻣـﻮﺿﻌﻲ ﺩﺭﻣﺎﻥ ﺷﺪﻧﺪ. ﺑﻴﻤﺎﺭ ﭼﻬﺎﺭﻡ ﺩﭼﺎﺭ ﺍﺣﺘﺒـﺎﺱ ﺍﺩﺭﺍﺭ ﻭ ﻋﻔﻮﻧﺖ ﻣﺜـﺎﻧﻪ ﺷﺪﻩ ﺑﻮﺩ ﻛﻪ ﺳﺎﺑﻘﺔ ﻗﺒﻠـﻲ ﻣﺸﻜﻼﺕ ﺍﺩﺭﺍﺭﻱ ﺩﺍﺷـﺖ ﻭ ﺑﺎ ﺩﺭﻣـﺎﻥ ﻃﺒﻲ ﺑﻬﺒـﻮﺩ ﻳﺎﻓـﺖ. ﻫﻴـﭻ ﺍﺷﻜﺎﻝ ﻋﻤﻠـﻜﺮﺩﻱ ﻳﺎ ﺑﻲ ﺍﺧﺘﻴـﺎﺭﻱ ﺩﺭ ﺩﻓـﻊ ﮔـﺎﺯ ﻳﺎ ﻣـﺪﻓﻮﻉ ﻣﺸﺎﻫـﺪﻩ ﻧﺸﺪ. ﺩﺭ ﻳﻚ ﭘﻴﮕﻴـﺮﻱ 30 ﻣﺎﻫـﻪ، 94 ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﻧﺘﻴـﺠﺔ ﻋﻤﻞ ﺭﺿﺎﻳﺖ ﺩﺍﺷﺘﻨﺪ. ﺑﺤﺚ ﻭ ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺩﺭﺩ ﻭ ﻧﺎﺭﺍﺣﺘﻲ ﺷﺪﻳﺪ ﻭ ﺩﻭﺭﺓ ﻧﻘﺎﻫﺖ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻛﻼﺳﻴﻚ ﺑﺮﺍﻱ ﻫﻤﻮﺭﻭﺋﻴﺪﻫﺎﻱ ﭘﺮﻭﻻﺑﻪ، ﻫﻤﻮﺭﻭﺋﻴﺪﻭﭘﻜﺴﻲ ﺑﺎ ﺍﺳﺘﺎﭘﻠﺮ ﻣﻲ ﺗﻮﺍﻧﺪ ﺟﺎﻳﮕﺰﻳﻨﻲ ﻣﻄﻤﺌﻦ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺍﻳﻦ ﮔﻮﻧﻪ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎﺷﺪ. ﺍﺯ ﺍﻣﺘﻴﺎﺯﻫﺎﻱ ﺍﻳﻦ ﺭﻭﺵ، ﻛﺎﻫﺶ ﺩﺭﺩ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺍﺳﺖ، ﺿﻤﻦ ﺍﻳﻦ ﻛﻪ ﻧﺘﺎﻳﺞ ﺩﺭﺍﺯ ﻣﺪﺕ ﺁﻥ، ﺍﺯ ﻧﻈﺮ ﻋﻮﺍﺭﺽ ﻫﻨﮕﺎﻡ ﻋﻤﻞ ﻭ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ، ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺟﺮﺍﺣﻲ ﻛﻼﺳﻴﻚ، ﻗﺎﺑﻞ ﻗﺒﻮﻝ ﺍﺳﺖ.

Introduction & Objective: Significant postoperative pain, defecation problems and relatively long recovery period encouraged researchers to find a safe substitute for conventional Milligan - Morgan hemorrhoidectomy. This study shows the results of our experience with stapled hemorrhoidopexy as one of these methods Material & Methods: From 1999 to 2005, 47 patients (31 male and 16 female) with an average age of 53 years underwent stapled hemorrhoidopexy in Arad General Hospital. All of these patients were prospectively evaluated for 6 months after surgery. The degree of hemorrhoids were grade 2 in 23.4%, grade 3 in 63.9%, grade 4 in 10.6% and one case of rectal prolapse. Results: The average length of operation was 38 min (30-60 min). Mean hospital stay was 1.3 days (1- 3 days). There was no intraoperative complication. The number of 4 cases (8.5%) was complicated: One case with rectal bleeding readmitted 48 hours after surgery. There was no pathologic finding in rectoscopy; after receiving 2 packed cell unit the patient was discharged. In 2 cases of reprolapse, one case was treated by sclerosing injection and the other by local resection of hemorrhoidal pile; and finally, one case with postoperative urinary retention and cystitis had history of urinary problems before the surgery. Neither functional nor incontinency to gas and liquids was presented with a mean follow up of 30 months. Overall of 85.1% (40 cases) of patients were fully satisfied. Conclusions: In spite of severe pain and discomfort and often a prolonged recovery period after conventional operation, stapled hemorrhoidopexy is an effective and safe alternative means of treating prolapsing hemorrhoid. Besides of decreased or eliminated postoperative pain, perioperative and late complications rate were also totally acceptable.