Giordano Pasquale, Overton John, Madeddu Francesco, Zaman Sabir, Gravante Gianpiero
Department of Surgery, Whipps Cross University Hospital, London, United Kingdom.
Dis Colon Rectum. 2009 Sep;52(9):1665-71. doi: 10.1007/DCR.0b013e3181af50f4.
Transanal hemorrhoidal dearterialization consists of a Doppler-guided ligation of the distal branches of the rectal arteries. The aim of this review is to assess the current evidence on dearterialization, establish the safety and efficacy of the technique, define its indications, and identify its possible advantages and limitations.
All published studies on dearterialization without language restrictions were reviewed systematically. Primary outcome measures were postoperative pain and hemorrhoidal recurrences.
Seventeen articles including a total of 1,996 patients were analyzed. In general, the quality of the studies was low. Operating time ranged between 5 and 50 minutes. Hospital stay was one day for most patients, whereas the return to normal activities was between two and three days in most cases. Postoperative pain was present in 18.5% of patients. Three patients experienced significant postoperative hemorrhages. There were no other major complications. The overall recurrence rate was 9.0% for prolapse, 7.8% for bleeding, and 4.7% for pain at defecation. The recurrence rate at one year or more was 10.8% for prolapse, 9.7% for bleeding, and 8.7% for pain at defecation. When reported as a function of the hemorrhoidal grade, the recurrence rate was higher for fourth-degree hemorrhoids (range, 11.1-59.3%).
Transanal hemorrhoidal dearterialization appears to be a potential treatment option for second-degree and third-degree hemorrhoids. Clinical trials and longer follow-up comparing it with other procedures used to treat hemorrhoids are needed to establish a possible role for this technique.
经肛门痔动脉结扎术是在多普勒引导下结扎直肠动脉的远端分支。本综述的目的是评估当前关于痔动脉结扎术的证据，确定该技术的安全性和有效性，明确其适应证，并找出其可能的优点和局限性。
系统回顾了所有已发表的关于痔动脉结扎术的研究，无语言限制。主要结局指标为术后疼痛和痔复发情况。
分析了17篇文章，共纳入1996例患者。总体而言，研究质量较低。手术时间为5至50分钟。大多数患者住院时间为1天，而在大多数情况下，恢复正常活动的时间为2至3天。18.5%的患者出现术后疼痛。3例患者发生了严重的术后出血。无其他严重并发症。脱垂的总体复发率为9.0%，出血为7.8%，排便疼痛为4.7%。脱垂、出血和排便疼痛在1年及以上的复发率分别为10.8%、9.7%和8.7%。按痔分级报告时，Ⅳ度痔的复发率较高（范围为11.1% - 59.3%）。
经肛门痔动脉结扎术似乎是Ⅱ度和Ⅲ度痔的一种潜在治疗选择。需要进行临床试验并进行更长时间的随访，将其与其他治疗痔的方法进行比较，以确定该技术可能发挥的作用。
