Department of Surgery A, Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weitzman Street, 64239, Tel-Aviv, Israel.
Tech Coloproctol. 2011 Sep;15(3):267-71. doi: 10.1007/s10151-011-0699-z. Epub 2011 Jun 16.
To evaluate the long-term results, early and late complication rates, and overall satisfaction of patients with grade III hemorrhoids treated by stapled hemorrhoidopexy (SH) or Doppler-guided hemorrhoidal artery ligation (DGHAL).
Operative and follow-up patients' data were prospectively collected for patients undergoing either SH or DGHAL by a single surgeon during a 2-year period. A retrospective comparison between patients' outcome operated by one of the two methods was made based on this data. Clinical data on postoperative pain, analgesic requirements, time to first bowel movement and functional recovery were collected at five postoperative follow-up visits (1 and 6 weeks, 6, 12, and 18 months). Data on patient satisfaction, recurrence of hemorrhoidal symptoms and further treatments were obtained by a standardized questionnaire that was conducted during the last visit 18 months postoperatively.
A total of 63 patients underwent SH (aged 52 ± 3.2 years) and 51 patients underwent DGHAL (aged 50 ± 7.3 years). DGHAL patients experienced less postoperative pain as scored by pain during bowel movement (2.1 ± 1.4 vs. 5.5 ± 1.9 for SH), and required fewer analgesics postoperatively. Hospital stay, time to first bowel movement, and complete functional recovery were also significantly shorter for the DGHAL patients. Nine DGHAL patients (18%) suffered from persistent bleeding or prolapses and required additional treatment compared with 2 (3%) patients in the SH group. SH patients reported greater satisfaction compared with DGHAL patients at 1 year postoperatively.
Both SH and DGHAL are safe procedures and have similar effectiveness for treating grade III hemorrhoids. DGHAL is less painful and provides earlier functional recovery, but is associated with higher recurrence rates and lower satisfaction rates compared with SH.
评估采用吻合器痔上黏膜环切术（SH）或多普勒引导痔动脉结扎术（DGHAL）治疗 III 度痔的长期疗效、早期和晚期并发症发生率以及患者总体满意度。
对一位外科医生在 2 年内采用这两种方法之一为患者进行手术的患者的手术和随访数据进行前瞻性收集。在此数据基础上，对采用这两种方法之一进行手术的患者的结果进行回顾性比较。在术后 5 次随访（术后 1 周和 6 周、6 个月、12 个月和 18 个月）中收集术后疼痛、镇痛需求、首次排便时间和功能恢复的临床数据。通过在术后 18 个月的最后一次就诊中进行标准化问卷调查获得患者满意度、痔症状复发和进一步治疗的相关数据。
共有 63 例患者接受了 SH（年龄 52 ± 3.2 岁），51 例患者接受了 DGHAL（年龄 50 ± 7.3 岁）。DGHAL 患者的术后排便疼痛评分（2.1 ± 1.4 对 SH 的 5.5 ± 1.9）较低，术后需要的镇痛药也较少。DGHAL 患者的住院时间、首次排便时间和完全功能恢复也明显较短。9 例 DGHAL 患者（18%）出现持续出血或脱垂，需要进一步治疗，而 SH 组只有 2 例（3%）患者需要进一步治疗。与 DGHAL 组相比，SH 组患者在术后 1 年时报告的满意度更高。
SH 和 DGHAL 都是安全的手术方法，治疗 III 度痔的效果相似。与 SH 相比，DGHAL 疼痛较轻，功能恢复较早，但复发率较高，患者满意度较低。
