Colorectal Unit, Department of Surgery, University Hospital, BP 217, Grenoble Cedex, France.
Dis Colon Rectum. 2011 Feb;54(2):226-31. doi: 10.1007/DCR.0b013e318201d31c.
Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of symptomatic hemorrhoids that has been applied successfully for grade II and III hemorrhoids but is less effective for grade IV hemorrhoids. Development of a special proctoscope enabled the combination of hemorrhoidal artery ligation with transanal rectoanal repair (mucopexy), which serves to lift and then secure the protruding hemorrhoids in place.
The purpose of this study was to describe our experience with this combined procedure in the treatment of grade IV hemorrhoids.
Prospective observational study.
Outpatient colorectal surgery unit.
Consecutive patients with grade IV hemorrhoids treated from April 2006 to December 2008.
Hemorrhoidal artery ligation-rectoanal repair.
Operating time, number of ligations, number of mucopexies and associated procedures, and postoperative symptoms were recorded. Pain was graded on a visual analog scale. Follow-up was at 2, 6, and 12 months after surgery, and then annually.
A total of 100 consecutive patients (64 women, 36 men) with grade IV hemorrhoids were included. Preoperative symptoms were bleeding in 80 and pain in 71 patients; 19 patients had undergone previous surgical treatment for the disease. The mean operative time was 35 (range, 17-60) minutes, with a mean of 9 (range, 4-14) ligations placed per patient. Eighty-four patients were discharged on the day of the operation. Nine patients developed early postoperative complications: pain in 6, bleeding in 4, dyschezia in 1, and thrombosis of residual hemorrhoids in 3. Late complications occurred in 4 patients and were managed conservatively. Recurrence was observed in 9 patients (9%), with a mean follow-up of 34 (range, 14-42) months.
The 2 main weaknesses of the study were the lack of very long-term follow-up and the absence of a comparison with hemorrhoidectomy or hemorrhoidopexy.
Doppler-guided hemorrhoidal artery ligation with rectoanal repair is safe, easy to perform, and should be considered as an effective option for the treatment of grade IV hemorrhoids.
多普勒引导痔动脉结扎术是一种微创技术，已成功应用于治疗 II 度和 III 度痔，但对 IV 度痔的效果较差。一种特殊直肠镜的开发使痔动脉结扎术与经肛门直肠直肠修复术（黏膜固定术）相结合成为可能，这有助于提升并固定突出的痔。
本研究旨在描述我们在治疗 IV 度痔中应用这种联合手术的经验。
前瞻性观察性研究。
门诊结直肠外科单位。
2006 年 4 月至 2008 年 12 月连续收治的 IV 度痔患者。
痔动脉结扎-直肠直肠修复。
记录手术时间、结扎次数、黏膜固定术和相关手术次数以及术后症状。疼痛程度采用视觉模拟评分法进行分级。术后 2、6、12 个月及以后每年进行随访。
共纳入 100 例连续 IV 度痔患者（64 例女性，36 例男性）。术前症状为出血 80 例，疼痛 71 例；19 例患者曾因该病接受过手术治疗。手术时间平均为 35 分钟（范围，17-60 分钟），平均每位患者结扎 9 次（范围，4-14 次）。84 例患者在手术当天出院。9 例患者术后早期出现并发症：疼痛 6 例，出血 4 例，排便困难 1 例，残余痔血栓形成 3 例。4 例患者出现晚期并发症，均保守治疗。9 例（9%）患者复发，平均随访 34 个月（范围，14-42 个月）。
本研究的 2 个主要缺陷是缺乏长期随访和缺乏与痔切除术或痔固定术的比较。
多普勒引导痔动脉结扎术联合直肠直肠修复术安全、易于操作，应被视为治疗 IV 度痔的有效选择。
