痔核術後こう門狭窄の解析と対策

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  • Analysis and Measures for Anal Stenosis After Hemorrhoidectomy.

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We studied 23 cases with postoperative anal stenosis, selected from 298 cases of hemorrhoids for which surgery had been performed in our clinic during the period from August 1999 to August 2001. 1) In the cases with ligation excision (LE) at 1 to 4 sites, postoperative anal stenosis developed, at incidences of 0%, 3.3%, 7.0% and 14.3%, respectively. These cases were classified into those with LE at 1 to 3 sites, and those with LE at 4 sites, and these were compared with each other. The former was found at 6.2 %, and the latter at 14.3 %, with the latter incidence being significantly higher. Therefore, the cases with LE at 3 sites or less seemed adequate. 2) After surgery for incarcerated hemorrhoids, anal stenosis developed significantly more fre-quently compared with after surgery for non-incarcerated hemorrhoids. Therefore, it is recommended that radical surgery should be performed after the improvement of incarceration. 3) In the cases with stenosis be-fore surgery, stenosis was also likely to develop after surgery. Number of LE was lower, and it was judged that anal dilatation is needed during surgery. 4) In the cases with high anal tension found by digital examina-tion before surgery, there was a higher possibility of stenosis after surgery. Therefore, it was judged that the number of LE should be fewer and operative anal dilatation should be added. 5) Anal stenosis was often improved during the period from 3 to 6 months after surgery. Of these cases, 64.3% were improved by non-invasive methods.

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