Department of Surgery, Faculty of Medicine, University of Alexandria, Ramleh Station, Alexandria, Egypt.
Dis Colon Rectum. 2010 Aug;53(8):1161-7. doi: 10.1007/DCR.0b013e3181e1a1e9.
PURPOSE: This study was designed to compare the outcome of LigaSure hemorrhoidectomy and stapled hemorrhoidopexy for prolapsed hemorrhoids. METHODS: Consecutive patients with grade III or IV hemorrhoids were randomly assigned to undergo either LigaSure hemorrhoidectomy or stapled hemorrhoidopexy. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, number of parenteral analgesic injections, duration of hospital stay, and time to return to work were all prospectively collected. Postoperative complications and recurrence of prolapse were also recorded. Patients were regularly followed for a total period of 12 months. RESULTS: A total of 68 patients completed the study (34 per group). Patient demographic and clinical characteristics were similar in the 2 groups. No significant differences between LigaSure hemorrhoidectomy and stapled hemorrhoidopexy were observed in mean operating time, postoperative pain score, number of parenteral analgesic injections, duration of hospital stay, or time to return to work. The groups were also similar regarding postoperative complications, except that at 4 weeks postoperatively, residual prolapse was observed in 8 patients (23.5%) in the stapled hemorrhoidopexy group vs. 2 patients (5.9%) in the LigaSure group (P = .040). Rate of recurrence of prolapse at 1 year was higher with stapled hemorrhoidopexy (4 patients, 11.8%) than with the LigaSure procedure (1 patient, 2.9%), but the difference was not significant (P = .163). CONCLUSIONS: LigaSure hemorrhoidectomy and stapled hemorrhoidopexy yield comparable good results, with a short operative time and minimal side effects in the treatment of grade III and IV hemorrhoids, but with a lower rate of residual prolapse for the LigaSure procedure. Both procedures offer low levels of postoperative pain and therefore are excellent therapeutic options for prolapsed grade III and IV hemorrhoids. A larger controlled study is needed to reach solid conclusions regarding risk of postoperative recurrence of hemorrhoidal prolapse.
目的：本研究旨在比较 LigaSure 痔切除术和吻合器痔上黏膜环切术治疗脱垂痔的疗效。
方法：连续患有 III 度或 IV 度痔的患者被随机分配接受 LigaSure 痔切除术或吻合器痔上黏膜环切术。前瞻性收集患者的人口统计学和临床特征、手术细节、术后视觉模拟评分的疼痛评分、注射止痛药的次数、住院时间和恢复工作的时间。还记录了术后并发症和脱垂复发情况。患者定期随访 12 个月。
结果：共有 68 例患者完成了研究（每组 34 例）。两组患者的人口统计学和临床特征相似。LigaSure 痔切除术和吻合器痔上黏膜环切术在手术时间、术后疼痛评分、注射止痛药的次数、住院时间和恢复工作的时间方面无显著差异。两组在术后并发症方面也相似，只是在术后 4 周时，吻合器痔上黏膜环切术组有 8 例（23.5%）出现残留脱垂，而 LigaSure 组只有 2 例（5.9%）（P =.040）。1 年后脱垂复发率吻合器痔上黏膜环切术组（4 例，11.8%）高于 LigaSure 组（1 例，2.9%），但差异无统计学意义（P =.163）。
结论：LigaSure 痔切除术和吻合器痔上黏膜环切术治疗 III 度和 IV 度痔均能获得良好的效果，手术时间短，副作用小，但 LigaSure 组残留脱垂的发生率较低。两种手术均能减轻术后疼痛，因此是治疗 III 度和 IV 度脱垂痔的极好选择。需要更大的对照研究来确定吻合器痔上黏膜环切术治疗痔脱垂术后复发的风险。
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