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작성일 : 11-01-26 16:52
조현언원장2011년대장항문학회구연
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  제 44차 대한 대장 항문 학회 학술 대회에서

Clinical and physiologic characteristics and difference between Combined ALTA with Submucosal hemorrhoidectomy and

Plasma kinetics (or diathermy) with Submucosal hemorrhoidectomy 란 제목으로 구연을 하시게 되었읍니다

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Clinical and physiologic characteristics and difference between Combined ALTA with Submucosal hemorrhoidectomy and

Plasma kinetics (or diathermy) with Submucosal hemorrhoidectomy

 

Hyunun Cho , M.D.1 Jongsung Hwang, M.D.

Younghee Kim, Ph.

1Department of Surgery , Division of Colorectal Surgery , Hwamyeong Jangsiwon Hakwoon Colorectal Surgery Clinic,

Buk-gu Busan, South Korea

 

Background

; There are increasing number of study about ALTA(aluminum potassium sulfate and tannic acid,Ziohn) injection therapy to treat internal hemorrhoid.

But in recent study , there are many report about incomplete treatment and recurrence and side effect after ALTA injection therapy in Grade III or IV Int. hemorrhoid.

But in Grade II Int. hemorrhoid, the treatment result after ALTA injection therapy was good and very few side effect. so many surgeons recommend meticulous patient selection (Lee et al. J Korean Soc Coloproctol, vol 26. 2010) and combined treatment like Submucosal hemorrhoidectomy and ALTA injection therapy

 

 

 

 

 

Purpose;

In this study, we evaluate the clinical and physiologic result and difference of combined tx. of Submucosal hemorrhoidectomy with ALTA injection therapy and Submucosal hemorrhoidectomy with plasma kinetic (or diathermy) therapy

 

Study design and Methods;

From January 2009 to October 2010 , total 200 patients who had int. hemorrhoids (Golliger grade II-IV) were treated by Submucosal hemorrhoidectomy with plasma kinetic (or diathermy) therapy and Submucosal hemorrhoidectomy with ALTA injection therapy.

Submucosal hemorrhoidectomy with plasma kinetic (or diathermy) therapy group (Group A) were treated with Submucosal hemorrhoidectomy (main pile) and plasma kinetic (or diathermy in accessory pile).

And Submucosal hemorrhoidectomy with ALTA injection therapy group (Group B) were treated with Submucosal hemorrhoidectomy (main pile) and ALTA injection (4-6 ml in each accessory pile) therapy.

After operation ,we evaluated male/female ratio, age difference, operation type, accompanying disease, job difference, main grade of hemorrhoid, oxford score difference, normal delievery number, 24 hr VAS pain score, 24hr analgesic injection number, 24hr analgesic P.O. medication number,anal pain at first defecate,urinary difficulty, defecation habit change, constipation drug use, average hospital stay, anal pain duration after defecate, defecation frequency, patient's satisfaction level, side effect after operation . symptom at last F/U , and manometric study difference before and after operation in two groups.

And we also valuated 1) 24 hr VAS pain score 2) 24hr analgesic injection number 3)average hospital stay 4) anal pain at first defecate 5) patient's satisfaction level 6)side effect after operation

7)symptom at last F/U according to Job, IBS, Constipation, Operation type, accompanying disease, Grade of hemorrhoid, Oxford score, Operation number.

Statistical analysis was done with SPSS 12.0 and used the student t-test, ANOVA square test, Tukey-Kramer multiple comparison test ,chi-square test (Fisher's exact test) . And we determine the value is effective if p value< 0.05

 

 

Result;

There were no statistical difference in male/female ratio, age difference, operation type, accompanying disease, job difference, normal delievery number and IBS number between two groups.

There were improving result in 24 hr VAS pain score (p=0.000), anal pain duration after defecate (p=0.021) in Group B

There were improving result in defecation habit (p=0.003), defecation frequency(p=0.004), constipation drug use(p=0.03) in Group B. There were improving postoperative manometry physiologic result in Group B(drecreasing Rest,Squeeze, Push than preoperation) with statistical significance.(p=0.000, 0.031, 0.003) but in Group A , there were no statistical significance.

In patient's satisfaction level, there were improving result in Group B than Group A(4.13 vs 3.18) with statistical significance(p=0.007)

In side effect after operation, there were very few number of postoperative bleeding in Group B than Group A(1 vs 14) with statistical significance(p=0.003), but others no statistical significance. There were decreased patient's satisfaction level in constipation group with statistical significance.(p=0.026) and increased VAS pain score and 24hr analgesic injection but there were no statistical significance. There were increased average hospital stay according to increasing hemorrhoid grade with statistical significance(p=0.016) and increased 24 hr VAS pain score and analgesic use and P.O. medication but no-statistical significance.

In Oxford score, there were increased average hospital stay(p=0.01) and 24hr analgesic injection(p=0.031) and decreasing patient's satisfaction level (p=0.001) according to increasing oxford score with statistical significance.

In Operation number, there were increased 24 hr VAS score with statistical significance (p=0.000) and increasing average hospital stay and 24hr analgesic injection and decreasing patient's satisfaction level according to increasing operation number but it was no-statistical significance.

 

Conclusion;

We compaired Submucosal hemorrhoidectomy with ALTA injection therapy to Submucosal hemorrhoidectomy with plasma kinetic (or diathermy) therapy, and Submucosal hemorrhoidectomy with ALTA injection therapy group showed more superior result in 24 hr VAS pain score, anal pain duration after defecate, defecation habit,defecation frequency, postoperative manometry physiologic result , and also improved patient's satisfaction level with statistical significance. And there were very few number of postoperative bleeding(1%) with statistical significance.

There were decreased patient's satisfaction level in constipation patients, and increased average hospital stay according to increasing hemorrhoid grade and increased 24 hr VAS score with increasing operation number with statistical significance.

In oxford score ,there were increased average hospital stay and 24hr analgesic injection, and decreasing patient's satisfaction level according to increasing oxford score with statistical significance.

So, oxford score may be another predictive tool to estimate the result of anorectal operation.