摘要
PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed external hemorrhoids a fter conservative or surgical management. METHODS: Two hundred and thirty-one c onsecutive patients with thrombosed external hemorrhoids treated from 1990 to 20 02 were identified. Recurrence was defined as complete resolution of the index l esion with subsequent return of a thrombosed external hemorrhoid and did not inc lude patients with chronic symptoms. Data were gathered retrospectively. Multipl e potential risk factors were reviewed. RESULTS: The index thrombosed external h emorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemo rrhoid. A prior history was less common in the conservative group than in the su rgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P< 0.001 and P< 0.002) . In addition, the surgical group was more likely to report all three symptoms o f pain, bleeding, and a lump (P< 0.005). Mean follow-up was 7.6 months, with th e range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P< 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservat ive group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 perc ent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrenc e was 7.1 months in the conservative group vs. 25 months in the surgical group ( P < 0.0001). Survival analysis for time to recurrence of thrombosed external hem orrhoid indicated that time to recurrence was significantly longer for the surgi cal group (P < 0.0001). Logistic regression analysis of multiple factors (includ ing diverticular disease, constipation, straining, benign prostatic hypertrophy, diarrhea, skin tags, history of travel, anoreceptive sex, anal fissures, intern al hemorrhoids, and obesity) was performed to determine the outcome of each grou p. None of these variables were significant predictors of recurrence. CONCLUSION S: Patients whose initial presentation was pain or bleeding with or without a lu mp were more like to be treated surgically. Surgically treated patients had a lo wer frequency of recurrence and a longer time interval to recurrence than conser vatively treated patients. None of the variables analyzed were significant predi ctors of a particular treatment, except for a prior history of thrombosed extern al hemorrhoids, which may represent patient choice. Although most patients treat ed conservatively will experience resolution of their symptoms, excision of thro mbosed external hemorrhoids results in more rapid symptom resolution, lower inci dence of recurrence, and longer remission intervals.
PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed external hemorrhoids a fter conservative or surgical management. METHODS: Two hundred and thirty-one c onsecutive patients with thrombosed external hemorrhoids treated from 1990 to 20 02 were identified. Recurrence was defined as complete resolution of the index l esion with subsequent return of a thrombosed external hemorrhoid and did not inc lude patients with chronic symptoms. Data were gathered retrospectively. Multipl e potential risk factors were reviewed. RESULTS: The index thrombosed external h emorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemo rrhoid. A prior history was less common in the conservative group than in the su rgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P< 0.001 and P< 0.002) . In addition, the surgical group was more likely to report all three symptoms o f pain, bleeding, and a lump (P< 0.005). Mean follow-up was 7.6 months, with th e range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P< 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservat ive group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 perc ent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrenc e was 7.1 months in the conservative group vs. 25 months in the surgical group ( P < 0.0001). Survival analysis for time to recurrence of thrombosed external hem orrhoid indicated that time to recurrence was significantly longer for the surgi cal group (P < 0.0001). Logistic regression analysis of multiple factors (includ ing diverticular disease, constipation, straining, benign prostatic hypertrophy, diarrhea, skin tags, history of travel, anoreceptive sex, anal fissures, intern al hemorrhoids, and obesity) was performed to determine the outcome of each grou p. None of these variables were significant predictors of recurrence. CONCLUSION S: Patients whose initial presentation was pain or bleeding with or without a lu mp were more like to be treated surgically. Surgically treated patients had a lo wer frequency of recurrence and a longer time interval to recurrence than conser vatively treated patients. None of the variables analyzed were significant predi ctors of a particular treatment, except for a prior history of thrombosed extern al hemorrhoids, which may represent patient choice. Although most patients treat ed conservatively will experience resolution of their symptoms, excision of thro mbosed external hemorrhoids results in more rapid symptom resolution, lower inci dence of recurrence, and longer remission intervals.
