Department of Surgery 'A', Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weitzman Street, 64239, Tel-Aviv, Israel.
Tech Coloproctol. 2012 Aug;16(4):291-4. doi: 10.1007/s10151-012-0844-3. Epub 2012 Jun 1.
Doppler ultrasonography enables accurate identification of the terminal branches of the superior rectal artery prior to hemorrhoidal artery ligation (HAL). However, since the positions of these branches have been found to be relatively constant, the question arises as to the necessity of ultrasonography for their identification. The aim of the current study was to examine the positions of all arteries identified and ligated during the HAL procedure.
We recorded the position of all arteries located and ligated in 135 consecutive patients who underwent the HAL procedure during the years 2003 to 2006.
In all patients, 6-8 terminal arterial branches were located above the dentate line. In 102 (76 %) patients, terminal branches were located in all 6 of the odd-numbered clock positions around the anus (1, 3, 5, 7, 9, and 11 o'clock in the lithotomy position). If we had ligated arteries only at these odd-numbered clock positions, without using Doppler ultrasonography, we would have located all the arteries in 96 (71 %) of our patients.
The number and location of arterial branches of the superior rectal artery are relatively constant. Nevertheless, if, Doppler ultrasonography had not been performed and, ligation in the HAL procedure had been at the odd-numbered clock positions only, then at least one artery would have been missed in 29 % of our patients.
多普勒超声检查能够在痔动脉结扎术（HAL）前准确识别直肠上动脉的终末支。然而，由于这些分支的位置被发现相对恒定，因此存在一个问题，即是否有必要对其进行超声检查来识别。本研究的目的是检查在 HAL 手术过程中识别和结扎的所有动脉的位置。
我们记录了 2003 年至 2006 年间连续 135 例接受 HAL 手术患者的所有定位和结扎的动脉的位置。
在所有患者中，6-8 条终末动脉分支位于齿状线以上。在 102 例（76%）患者中，终末分支位于肛门周围所有 6 个奇数时钟位置（截石位 1、3、5、7、9 和 11 点）。如果我们仅在这些奇数时钟位置结扎动脉，而不使用多普勒超声检查，那么在我们的 96 例（71%）患者中，我们会定位到所有动脉。
直肠上动脉的分支数量和位置相对恒定。然而，如果没有进行多普勒超声检查，并且在 HAL 手术中仅结扎奇数时钟位置，那么我们的 29%的患者中至少有一条动脉会被遗漏。
