대한대장항문학회

치핵환자는 Haycock과 Smith 및 Arabi등에 의하면 정상인보다 항문압이 높고 치핵절제<br>술시 괄약근 수지확장법이나 내괄약근 부분절개술을 병행하는 것이 효과적이며 이학적검사<br>로 측정한 항문압은 실제 측정한 항문압과 차이가 있어 부정확하다고 하였다. 또한 국내에<br>서는 치핵환자에서 수술전과 내괄약근 부분절개술후 항문압을 측정한 예가 없고 한국인의<br>정상항문압과 치핵환자의 항문압에 대한 보고가 미비하여 치핵군, 주사요법군, 수술군, 대조<br>군에서 항문압을 측정하여 다음과 같은 결과를 얻었다.<br>1) 치핵환자의 휴식항문압(91±23 mmHg)은 대조군의 휴식항문압(63±16 mmHg)보다 유<br>의하게 높았다(p<0.001).<br>2) 치핵환자의 수축항문압(137±32 mmHg)은 대조군이 수축항문압(98±28 mmHg)보다<br>유의하게 높았다(P< 0.001).<br>3) 주사요법군의 휴식항문압(72±17 mmHg) 및 수축항문압(125±68 mmHg)은 대조군과<br>유의한 차이가 없었다.<br>4) 수술군의 휴식항문압(51±13 mmHg)은 대조군에 비해 유의하게 감소되었으나(p<0.01)<br>수축항문압 (97±26 mmHg)은 대조군과 유의한 차이가 없었다.<br>이상의 결과로써 치핵환자에서는 비정상적으로 항문압이 증가되어 있고 이는 항문내괄약<br>근 기능항진에 의한 것으로 술전 항문압이 증가된 치핵환자에서 치핵절제술시 내괄약근 부<br>분절개술을 병행하는 것이 이론적으로 타당하다는 것을 알 수 있다.<br>#초록#<br>Patients with hemorrhoid and anal fissure are considered to have<br>significantly<br>associated resting anal pressures than controls. These findings are used to support the<br>argument that operations such as manual dilatation of the anus and lateral internal<br>sphincterotomy will correct the primary abnormality and achieve long term pressure<br>reduction in anal canal. By selecting patients with high Pressure we hoped to define<br>those patients likely to benefit from manual dilatation of the anus and lateral internal<br>sphincterotomy.<br>Resting anal Pressure and voluntary maximal anal contraction pressure were stuied in<br>26 patients(23 male, 3 female) with hemorrhoid who have no previous treatment, in 10<br>patients(8 male, 2 female) with hemorrhoid who have previous injection therapy history,<br>in 13 patients(7 male, 6 female) who have had hemorrhoidectomy with lateral internal<br>sphincterectomy 3 months ago and 19(all male) asymptomatic control subjects in whom<br>the anal canal was considered normal on proctoscopy.<br>Pressure recordings were taken after proctoscopy in both patients and volunteer<br>controls. With the patient in the left lateral decubitus position both resting anal pressure<br>and maximum voluntary anal contraction pressure were recorded 10 cm from anal verge<br>using a water filled polyethylene catheter connected to a pressure measurement<br>transducer and a recording device, then the catheter was pulled a constant rate with a<br>mechanical pulling device.<br>The results were as follows:<br>1) The mean resting anal pressure in Patients with hemorrhoid, who halve no<br>Previous, treatment, (91?3 mmHg) was very significantly higher than that of the<br>control subjects(62?5 mmHg)(p< 0.001).<br>2) The mean maximum voluntary anal contraction pressure in patient with hemorrhoid,<br>who have no previous treatment, (136?2 mmHg) was very significantly higher than<br>that of the control subjects(98?8 mmHg)(p< 0.001).<br>3) The mean resting anal pressure(72?7 mmHg) and mean maximum voluntary anal<br>contraction Pressure(125?8 mmHg ) in patient with hemorrhoid with previous injection<br>therapy were not significantly different than those of control subjects.<br>4) The mean resting anal pressure in patient with previous hemorrhoidectomy and<br>lateral sphincterotomy (51?3 mmHg) was significantly lower than that of the control<br>subjects(P<0.01). But the mean maximum voluntary anal contraction Pressure(97?6<br>mmHg) was not significantly different than that of the control subjects.<br>The results suggested that it is nessary to measure anal pressure in patients with<br>hemorrhoid for the treatment and evaluation of therapeutic effect. And inappropriate<br>injection therapy should be avoided to prevent anal sphincter injury and anal stenosis.<br>The patients who had hemorrhoidectomy and lateral internal sphincterotomy revealed a<br>very significantly decreased resting anal pressure without incontinence and we could<br>measure an intact voluntary anal contraction pressure.<br>