Doença hemorroidária: aspectos epidemiológicos e diagnósticos de 9.289 pacientes portadores de doença hemorroidária

[摘要] In a 38-year period of practice in Coloproctology, from 1965 to 2003, the author had the opportunity to attend 34,000 patients. Diagnose of hemorrhoids as the main cause of the symptoms presented was achieved in 9,289 patients (27.3%). 2,417 of the 9,289 patients (26.00%) were submitted to hemorroidectomy. The aim of this report is to analyse these patients as far as epidemiologic aspects are concerned: age, gender, classification and grade of hemorrhoids, symptoms and proctologic findings as well as concomitant anorectal diseases and surgical treatment.As far as gender is concerned the incidence of hemorrhoids was statistically significant higher among women (5,007 cases, 53.9%) than in men (4,282 cases, 46.1%). And although not statistically significant surgery for hemorrhoids for women (1,330 : 5,007) was more common (26.6%) than in men (1,087 : 4,282) (25.4%). But in relation to the patients who underwent hemorrhoidectomy (2,417) the surgery was statistically significant more commom among women (1,330 : 2,417 or 55.0%) than in men (1,087 : 2,417 or 45.0%).Mean age of the patients by occasion of diagnose of hemorrhoids was 39.9 year, being 74.8% between 21 and 50 year of age. Mean age by occasion of surgery was 41.6 year, being 71.8% between 21 and 50 year of age.The most frequent symptoms presented by the patients were anal piles (90.5%), blood in the stools (83.0%), rectal exteriorization during defecation (71.0%) and anal pain (54.0%).As far as graduation of the disease is concerned, third grade hemorrhoids was more common (36.9%), following second (28.3%) and fourth (20.3%) grades. Surgery was more common in fourth grade hemorrhoids (60.2%), following anal external piles (30.9%) and third grade hemorrhoids (30.5%).In 1,122 patients hemorrhoids were associated with several anore ctal diseases (12.1%), with emphasis to anal fissures (5.8%) and hyperthrofied anal papila (3.4%). The incidence of surgery for associated anorectal disease was 13.1% (729 patients), being fissurectomy (13.1%) and papilectomy (11.0%) the two more frequently surgery carried out during hemorroidal approach.

[学科分类] 心脏病和心血管学

[关键词] hemorroidal disease;hemorrhoids;hemorrhoidectomy;epidemiology;anal diseases     INTRODUÇÃOHISTÓRICO: Desde a mais remota antigüidade (antigas civilizações grega e egípcia) o tema "hemorróidas" tem sido muito discutido;mas continua controverso sob determinados aspectos;quando o próprio termo que remonta a uma etimologia grega (Haemos = sangue Rhoos = derramar);descreve um sintoma (sangramento) que nem sempre está presente;mesmo em casos avançados de prolapsos volumosos (Santos;1999 34;35)