Surgical Unit, Santa Maria dei Battuti Hospital, S. Vito al Tagliamento (PN), Italy.
Colorectal Dis. 2010 Aug;12(8):804-9. doi: 10.1111/j.1463-1318.2009.01915.x.
We report a multicentric prospective study which aimed to evaluate Doppler-assisted ligation of the terminal haemorrhoidal arteries (THD) for II and III degree haemorrhoids.
A total of 112 patients from five colorectal units, including 81 men, mean age 48 +/- 13 years, with II degree (39) and III degree (73) haemorrhoids were treated by Doppler-guided transanal de-arterialization and anopexy using a new device (THD).
The mean operative time was 33.9 +/- 8.8 minutes, and the mean number of ligatures applied was 7.2 +/- 1.5. Postoperatively, 72% of patients did not need analgesics and the other 28% used nonsteroidal antiinflammatory drugs 1-3 times/day for less than 2 days. All the patients were operated as a day case. Early postoperative complications included haemorrhoidal thrombosis (2 patients), bleeding (1) treated by haemostatic suture, dysuria (6) and acute urinary retention (1). After a mean follow-up of 15.6 +/- 6.5 months (range 6-32), 2/105 (20.9%) patients complained of minor bleeding, while mild pain was still present in 4/51 patients (7.8%). There were no statistically significant differences in the sample population regarding the gender or stage of the disease. Tenesmus was cured in 15/17 patients, dyschaezia in 20/22 patients and mucous soiling in 10/10 patients. No new cases of altered defaecation or faecal incontinence were recorded. Overall, 85.7% of patients were cured and 7.1% improved. Residual haemorrhoids were treated by elastic band ligation in nine (8%) patients and by surgical excision in further five patients (4.5%).
Doppler-assisted ligation of the terminal branches of the haemorrhoidal arteries for II and III degree haemorrhoids is highly effective and painless. Complications are few and the technique can be performed as a day case.
我们报告了一项多中心前瞻性研究，旨在评估多普勒辅助结扎痔动脉终末支（THD）治疗 II 度和 III 度痔的效果。
来自五个直肠结肠单位的 112 例患者，包括 81 名男性，平均年龄 48 +/- 13 岁，其中 II 度（39 例）和 III 度（73 例）痔，采用多普勒引导下经肛门动脉去血管化和新型装置（THD）直肠黏膜环切术治疗。
平均手术时间为 33.9 +/- 8.8 分钟，平均结扎数为 7.2 +/- 1.5 个。术后 72%的患者无需使用镇痛药，28%的患者使用非甾体抗炎药 1-3 次/天，持续时间不超过 2 天。所有患者均作为日间手术进行。早期术后并发症包括痔血栓形成（2 例）、出血（1 例），采用止血缝合治疗，排尿困难（6 例）和急性尿潴留（1 例）。平均随访 15.6 +/- 6.5 个月（6-32 个月）后，2/105（20.9%）患者诉有轻微出血，51 例患者中有 4 例（7.8%）仍有轻度疼痛。在研究人群中，性别或疾病分期无统计学差异。17 例患者中 15 例治愈肛门直肠疼痛，22 例患者中 20 例治愈排便困难，10 例患者中 10 例治愈黏液污染。未记录到新的排便改变或粪便失禁病例。总体而言，85.7%的患者治愈，7.1%的患者改善。9 例（8%）患者采用弹性带结扎治疗残留痔，5 例（4.5%）患者进一步行手术切除。
多普勒辅助结扎痔动脉终末支治疗 II 度和 III 度痔效果显著，且无痛。并发症少，可作为日间手术进行。
