Department of Surgery A, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 64239, Tel Aviv, Israel.
Tech Coloproctol. 2012 Feb;16(1):61-5. doi: 10.1007/s10151-011-0801-6. Epub 2011 Dec 22.
Doppler-guided hemorrhoidal artery ligation (DGHAL) was described as lower risk and a less painful alternative to hemorrhoidectomy. We report our experience and 5-year follow-up with this procedure.
Between May 2003 and December 2004, 100 patients with symptomatic Grade II or III hemorrhoids underwent ultrasound identification and ligation of 6-8 terminal branches of the superior rectal artery above the dentate line by a single surgeon using local, regional, or general anesthesia. There were 42 men and 58 women (mean age 42 years, median duration of symptoms 6/3 years). A 10-point visual analog scale was used for postoperative pain scoring. Surgical and functional outcome was assessed at 6 weeks and 3 and 12 months after surgery, with long-term follow-up by a telephone questionnaire at 5 years after the procedure.
The mean operative time was 19 min. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only 5 patients were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative period. The mean pain score decreased from 2.1 at 2 h postoperatively to 1.3 on the first postoperative day. All patients had complete functional recovery by the third postoperative day. Ninety-six patients completed 12 months of follow-up. Eighty-five of these patients (89%) remained asymptomatic at 12 months, though this number dropped to 67/92 (73%) at 5 years.
Long-term follow-up confirms the effectiveness of the DGHAL procedure for treatment for Grade II hemorrhoids. The DGHAL procedure alone seems less effective for Grade III hemorrhoids.
多普勒引导痔动脉结扎术（DGHAL）被描述为一种风险较低、疼痛较小的痔切除术替代方法。我们报告了我们使用这种方法的经验和 5 年随访结果。
在 2003 年 5 月至 2004 年 12 月期间，由一位外科医生对 100 名患有症状性 II 级或 III 级痔的患者进行了超声识别，并在齿状线以上结扎了 6-8 条直肠上动脉的终末分支，采用局部、区域或全身麻醉。其中 42 名男性和 58 名女性（平均年龄 42 岁，中位症状持续时间 6/3 年）。术后疼痛评分采用 10 分视觉模拟评分法。术后 6 周、3 个月和 12 个月评估手术和功能结果，并在术后 5 年通过电话问卷调查进行长期随访。
平均手术时间为 19 分钟。局部肛门阻滞联合静脉镇静（n=93）或全身或脊髓麻醉（n=7）用于麻醉。只有 5 名患者需要住院过夜。术后即刻无尿潴留、出血或死亡。术后 2 小时疼痛评分平均从 2.1 分降至第 1 天的 1.3 分。所有患者在术后第 3 天完全恢复功能。96 名患者完成了 12 个月的随访。其中 85 名患者（89%）在 12 个月时无症状，但在 5 年时降至 67/92（73%）。
长期随访证实了 DGHAL 手术治疗 II 级痔的有效性。单独使用 DGHAL 手术似乎对 III 级痔的效果较差。
