대한대장항문학회

To study to role of the anal pressure in the pathogenesis of various anal diseases,<br>particularly the hemorrhoid, the author measured the length of the functional anal canal,<br>the maximal pressure spot, the maximal anal resting pressure(MARP), and the maximal<br>anal contraction pressure(MACP) in 237 patients with benign anal diseases.<br>These<br>diseases fall under three categories(number of cases in parentheses); hemorrhoids, (176);<br>anal fissure, (34); anal fistula, (27). These patients visited the Department of General<br>Surgery at the Yeungnam University Hospital(YUH) between September 1990 and<br>March 1992.<br>The same data were collected from 42 controls who visited the YUH Physical<br>Chek-up unit during the same period. The results are as follows;<br>The length of the functional anal canal and the maximal pressure spot were 3.5 cm<br>and 1.5 cm, respectively, and these figures did not differ significantly between the<br>diseased and control groups. Relative to the control, MARP was considerably higher in<br>the anal fissure group, while MARP in hemorrhoid and anal fistula cases did not vary<br>significantly from the control. MACP was not significant in 4 groups.<br>MARP was found to be the most meaningful measure, and was thus analyzed further.<br>MARPs were first compared for various hemorrhoid symptoms, then for various states.<br>Among hemorrhoid patients, age and gender were not significant factors in the MARP<br>level. While MARP tended to be higher in patients suffering from constipation, this<br>trend was not statistically significant. MARP increased with the severity of bleeding,<br>but tended to decrease with the extent of mucosal prolapse. Both tendencies were<br>statistically significant.<br>Moreover, we observed a tendensy for MARP to decrease with the progression of<br>hemorrhoid. When the hemorrhoid occured only with prolapse, MARP was significantly<br>lower than the control. However, with anal fissure, MARP was significantly higher than<br>the control. In cases of multiple complicated anal fistula, or previous treatment of<br>hemorrhoids with sclerosing agents, MARP was significantly lower. This result was<br>thought to be caused by an inflammatory reaction in internal sphincter muscles<br>to<br>sclerosing agents.<br>In addition, internal sphincterotomy led to a considerable reduction in MARP within 3<br>months after the operation. The following conclusions were drawn from these results;<br>Hemorrhoids can develop in both high and low MARP. Therefore the dicision to<br>perform sphincterotomy at a hemorrhoidectomy should be made judiciously. In cases of<br>bleeding, the additional sphnicterotomy is recommended. In contrast,<br>internal<br>sphincterotomy is not recommended in case of mucosal prolapse. These guidelines will<br>help avoid threats to MARP.<br>