94 KB20 KB192920262003Košorok, PavleMlakar, BoštjanVelikonja, Antonstr. I-17-I-20ISSN:1318-0347COBISSID_HOST:16591065URN:URN:NBN:SI:doc-PBTXVLQ2slSlovensko zdravniško društvoZdravniški vestnikAnketeHemoroidiHemorrhoidsKirurške spenjalkePooperativna krvavitevPooperativne komplikacijePostoperative ComplicationsPostoperative HemorrhageQuestionnairesSurgerySurgical StaplersTreatment OutcomeZdravljenje, izidZgodnji zapleti in rezultati zdravljenja hemoroidov s krožnim mehaničnim spenjalnikom (PPH)| Early postoperative complications and results of stapler hemorrhoidectomy (PPH)|Background. From, January 2000 until May 2002 149 patients underwent stapled hemorrhoidectomy (PPH) at the Medical Centre IATROS. One day surgery was performed in spinal anaesthesia. Methods. We observed and analysed complications between 1 to 30 days after surgery. Long term follow-up ranged from 3 to 20 months. 76% of the patients returned the questionnaire we sent The patients with complaints were reexamined. Results. Earlypostoperative complications (surgical and anaesthesiological) were observed in 41 patients (27.5%). Three patients (2%) were hospitalized: two because of bleeding and one because ofpain andfever No surgery was needed. External anal thrombosis occured in 2 cases (1.3%), 7 patients had pain after defecations (4.7%) and 8 patients (5.4%) had fever and/or eleveated body temperature. Patients with fever and/or elevated body temperature were treated five days with klindamicin. Urine retention occured in 12 patients (8.1%). Headache was a probleme in 9 patients (6%). The patients were satisfied with operation in 93%of the cases, partially satisfied in 1.8% and unsatisfied with result of the operation in 5.2%. 8% of patients had blood on paper after defecation, andwe treated them with one or more rubber baud ligations. Two of them required clasic hemorrhoidectomy. 6.2% of patients had pain after defecation and we treated them with anal dilatators. Anal stenosis occured in 2.6%. In these cases we pinched off some parts of the stenosing scar and recomended useof anal dilatators. Minor anal incontinence after operation was made worse in 6.2% and improved in 0.9%. 1.8% of patients had problem with urgent defecation. Conclusions. Our experience with one day surgery for PPH is good. We belive that this surgical procedure is an effective method for the third degree hemorrhoids. We do not recomend PPH when severe external piles are dominant and when large tags accompany the hemorrhoidal prolapse. (Abstract truncated at 2000 characters)Izhodišča. V Medicinskem centru IATROS smo v času od januarja 2000 do maja 2002 operirali 149 bolnikov zaradi hemoroidov po postopku s krožnim mehaničnimspenjalnikom (PPH). Posege smo opravili ambulantno v spinalni anesteziji. Metode. Analizirali smo zgodnje zaplete v obdobju od Z do 30 dni po posegu. Dolgoročne rezultate (od 3 do 20 mesecev) smo analizirali s pomočjoankete, ki jo je vrnilo 76% operirancev. Rezultati. Zgodnje pooperativne zaplete (kirurške in anesteziološke) je imelo 41 operirancev (27,4%). Trije operiranci (2%) so bili hospitalizirani: dva zaradi krvavitve, eden pa zaradi bolečine in vročine. Kirurško ukrepanje ni bila potrebno. Tromboza zunanjega hemoroida se jepojavila pri dveh operirancih (1,3%), sedem operirancev (4,7%) je tožilo zaradi bolečin po odvajanju, pri osmih (5,4%) pa se je pojavila povišana temperatura in/ali mrzlica. Operirance s povišano temperaturo in mrzlico smo pet dni zdravili s klindamicinom. Urinska retenca se je pojavila pri dvanajstih operirancih (8,1%), pooperativni glavobol pa pridevetih (6%). Iz ankete smo izvedeli, da je bilo z operacijo zadovoljnih 93% operirancev, delno 1,8%, nezadovoljnih pa je bilo 5,2% operirancev. Kri napapirju ob odvajanju je navajalo 8% operirancev, večino smo dodatno zdraviliz elastičnimi ligaturami, dva pa sta potrebovala dodatno klasično operacijo. Bolečino po odvajanju je omenjalo 62% operirancev, zdravili smo jihz analnimi dilatatorji, odstranili morebitne sponke in šive, trem pa smo odrezali mesnate kožne gube. Analna stenoza v predelu resekcijske linije se jepojavila v 2,6%. Brazgotino smo odščipnili na treh mestih in svetovali uporabo analnih dilatatorjev. Poslabšanje analne inkontinence je navajalo 62% operirancev, v 0,9% pa se je izboljšala. V 1,8% se je pojavila urgentna defekacija. (Izvleček skrajšna pri 2000 znakih)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo