1st Propaedeutic Department of Surgery, Athens Medical School, Hippocration General Hospital, 114 Vas. Sofias Ave, 11527, Athens, Greece.
Tech Coloproctol. 2012 Jun;16(3):237-41. doi: 10.1007/s10151-012-0822-9. Epub 2012 May 5.
The isolated application of Doppler-guided haemorrhoidal artery ligation (DGHAL) may fail due to the increased reprolapse rate for high-grade haemorrhoids. DGHAL has been combined with a proctoscopic-assisted transanal rectal mucopexy of the prolapsing tissue. The technique is called rectoanal repair (RAR) and is an evolution of various mucopexy and suture haemorrhoidopexy (SHP) techniques. A prominent external component may require minimal (muco-) cutaneous excision (MMCE) of protruding anoderm or minor cutaneous excision of skin tags.
Fifty-seven patients with symptomatic Goligher grade III and IV haemorrhoids underwent DGHAL followed by either RAR or SHP. In 26 cases, the addition of MMCE was necessary.
No significant differences were observed between the two approaches with regards to pain scores measured with visual analogue scale (VAS). On postoperative day 1, mean pain score at rest was 5.81 (±2.23 SD) after SHP versus 5.08 (±2.35 SD) after RAR, while mean pain score at first defecation was 7.31 (±1.6 SD) versus 7.52 (±1.83 SD). There was no difference in the duration of analgesic requirements, postoperative complications and residual prolapse between the 2 procedures. The addition of MMCE did not affect postoperative pain nor analgesic requirements. With the exception of 8 patients who still had with skin tags or minimal protrusion, the remaining of patients (86 %) were asymptomatic and recurrence-free at an average follow-up of 20 months. Overall, 94.8 % of patients stated that they were satisfied with the results, and 91.2 % that they would repeat it if necessary.
Performance of either SHP or RAR after DGHAL is a safe and effective surgical tactic for advanced grade haemorrhoids. Our initial results do not confirm any superiority of RAR over traditional SHP.
由于高位痔的复发率增加，单独应用多普勒引导痔动脉结扎术（DGHAL）可能会失败。DGHAL 已与直肠镜辅助脱垂组织经肛门直肠黏膜固定术（RAR）相结合。该技术称为直肠肛门修复术（RAR），是各种黏膜固定术和缝合痔固定术（SHP）技术的发展。明显的外部成分可能需要切除突出的肛门皮肤的最小（黏膜）皮肤切除术（MMCE）或皮肤标签的小皮肤切除术。
57 例有症状的 Goligher Ⅲ度和Ⅳ度痔患者接受 DGHAL 治疗，然后行 RAR 或 SHP 治疗。在 26 例中，需要进行 MMCE。
两种方法在使用视觉模拟量表（VAS）测量的疼痛评分方面无显著差异。在术后第 1 天，SHP 后静息时平均疼痛评分为 5.81（±2.23SD），而 RAR 后为 5.08（±2.35SD），而首次排便时的平均疼痛评分为 7.31（±1.6SD）与 RAR 后 7.52（±1.83SD）。两种手术方式的镇痛需求持续时间、术后并发症和残留脱垂无差异。MMCE 的加入并不影响术后疼痛或镇痛需求。除 8 例仍有皮肤标签或最小突出外，其余患者（86%）在平均 20 个月的随访中无症状且无复发。总的来说，94.8%的患者表示对结果满意，如果需要，91.2%的患者会再次接受治疗。
DGHAL 后行 SHP 或 RAR 是治疗高级别痔的一种安全有效的手术策略。我们的初步结果并不证实 RAR 比传统 SHP 具有任何优势。
