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

Abstract

O objetivo deste trabalho é estudar 9.289 pacientes portadores de DH e 2.417 pacientes submetidos à hemorroidectomia, extraídos de um universo de 34.000 pacientes coloproctológicos examinados no decurso de 38 anos, analisando-se os dados epidemiológicos do diagnóstico e da cirurgia. A incidência de DH como diagnóstico principal entre 34.000 pacientes foi de 27,3% (9.289 pacientes), tendo 26,0% (2.417 pacientes) deles sido submetidos a cirurgia. Predominou, de forma estatisticamente significativa, a incidência de DH entre mulheres (5.007 : 9.289 ou 53,9%) sobre homens (4.282 : 9.289 ou 46,1%), da mesma forma que, mas sem significado estatístico, a incidência de cirurgias entre as mulheres portadoras de DH (1.330 : 5.007 ou 26,6%) sobre cirurgias em homens portadores de DH (1.087 : 4.282 ou 25,4%). Todavia, quando relacionada aos 2.417 pacientes operados, a incidência de cirurgia foi, de forma estatisticamente significativa, mais comum entre as mulheres (1.330 : 2.417 ou 55,0%) que entre os homens (1.087 : 2.417 ou 45,0%. A média etária de diagnóstico foi de 39,9 anos, com 74,8% entre 21 e 50 anos; e a média de cirurgia de 41,6 anos, com 71,8% entre 21 e 50 anos. Os sintomas mais comuns foram presença de mamilos anais (90,5%), sangue nas fezes (83,0%), exteriorização pelo ânus ao ato defecatório (71,0%), ardência anal (54,0%), escape (soiling) (44,0%) e sangue nas roupas (41,0%). Predominou a DH de segundo (28,3%), terceiro (36,9%) e quarto graus (20,3%), predominando a cirurgia na DH de terceiro grau (30,5%), quarto grau (60,2%) e plicomas anais (30,9%). A incidência de doenças anais concomitantes à DH foi de 12,1% (1.122 pacientes), destacando-se as fissuras anais (5,8%) e a hipertrofia de papilas anais (3,4%). A incidência de cirurgias para doenças anais concomitantes à DH no decurso das hemorroidectomias foi de 30,1% (729 pacientes), destacando-se as fissuras anais (13,1%) e hipertrofia de papilas anais (11,0%).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.