Greenberg Ron, Karin Eliad, Avital Shmuel, Skornick Yehuda, Werbin Nahum
Department of Surgery A', Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Dis Colon Rectum. 2006 Apr;49(4):485-9. doi: 10.1007/s10350-005-0281-8.
This study was designed to examine the benefits of a Doppler-guided hemorrhoidal artery ligation technique in terms of surgical outcome, functional recovery, and postoperative pain.
Using local, regional, or general anesthesia, 100 patients with symptomatic Grades II or III hemorrhoids underwent sonographic identification and suture ligation of six to eight terminal branches of the superior rectal artery above the dentate line. Visual Analog Scales were used for postoperative pain scoring. Surgical and functional outcomes were assessed at 6 weeks and 3, 6, and 12 months after surgery.
There were 42 (42 percent) males and 58 (58 percent) females (mean age, 42 years; median duration of symptoms, 6.3 years). The mean operative time was 19 minutes. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only five were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative course. The mean pain score decreased from 2.1 at two hours postoperative to 1.3 on the first postoperative day. All patients had a complete functional recovery by the third postoperative day. Ninety-four patients remained asymptomatic after a mean follow-up of six months: four patients required additional surgical excision, and two required rubber band ligations for persistent bleeding. On follow-up, there was no report of incontinence to gas or feces, fecal impaction, or persistent pain.
Our experience indicates that Doppler-guided hemorrhoidal artery ligation is safe and effective and can be performed as an outpatient procedure with local or regional anesthesia and with minimal postoperative pain and early recovery.
本研究旨在探讨多普勒引导下痔动脉结扎术在手术效果、功能恢复及术后疼痛方面的益处。
100例有症状的Ⅱ或Ⅲ度痔患者，采用局部、区域或全身麻醉，在齿状线以上对直肠上动脉的6至8个终末分支进行超声识别及缝扎。采用视觉模拟评分法对术后疼痛进行评分。在术后6周以及术后3、6和12个月评估手术和功能效果。
男性42例（42%），女性58例（58%）（平均年龄42岁；症状中位持续时间6.3年）。平均手术时间为19分钟。采用局部肛门阻滞联合静脉镇静（n = 93）或全身或脊髓麻醉（n = 7）。仅5例患者住院过夜。术后即刻过程中无尿潴留、出血或死亡情况。平均疼痛评分从术后2小时的2.1降至术后第1天的1.3。所有患者在术后第3天功能完全恢复。平均随访6个月后，94例患者无症状：4例患者需要额外手术切除，2例因持续出血需要橡皮圈套扎。随访时，无气体或粪便失禁、粪便嵌塞或持续性疼痛的报告。
我们的经验表明，多普勒引导下痔动脉结扎术安全有效，可在局部或区域麻醉下作为门诊手术进行，术后疼痛轻微且恢复早。
