射频手术在痔病治疗中的作用。

Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy.

Eur Rev Med Pharmacol Sci. 2012 Apr;16(4):548-53.

BACKGROUND

In this article we reported results obtained in our previous studies concerning application of radiofrequency (RF) in proctology and in particular for hemorrhoids treatment.

METHODS

We compared radiofrequency submucosal hemorrhoidectomy (RSH) and conventional Parks' hemorrhoidectomy (CPH) (group 1), radiofrequency open hemorrhoidectomy (ROH) and Milligan-Morgan hemorrhoidectomy (MMH) (group 2), radiofrequency closed hemorrhoidectomy (RCH) and Ferguson hemorrhoidectomy (FH) (group 3), combined hemorrhoidal radiocoagulation (CHR) and rubber band ligation (RBL) (group 4). In this work primary endpoints were determined as evaluation of the grade of pain felt immediately after the procedure and at the first evacuation, bleeding, operation time, readmission to work, incidence of failures and patient's satisfaction.

RESULTS

Group 1 - In comparison to Parks' technique, use of radiofrequency scalpel reduced mean operation time (61.2 min, range 50-75, vs. 37.4 min, range 30-51; p < 0.05), first postoperative day pain score (5.9, range 3-10, vs. 4.0, range 1-10; p < 0.05), pain score at first evacuation (5.7, range 2-10, vs 4.2, range 1-8; p < 0.05) and pain score on postoperative days (3.6, range 1-9, vs. 2.8, range 1-8; p < 0.05). Group 2 - Results show a substantial similarity between these techniques, however the procedure lasted 7 minutes less with RF scalpel (18.6 min, range 16-21, vs. 25.55 min, range 20-30; p < 0.05). Group 3 - Patients treated with RF showed significant reduction in surgical time (23 min, range 21-31, vs. 33 min, range 24-35; p < 0.01), in pain at 1st post-operative day (VAS score 3.4 +/- 1.3 vs. 4.8 +/- 1.0; p < 0.05) and at the first evacuation (3.4 +/- 1.0 vs. 5.0 +/- 0.8; p < 0.05). Group 4 - The study confirmed validity of both the used techniques, however CHR seems to allow a reduction in incidence of failures.

CONCLUSIONS

Results obtained from radiofrequency surgery compared with those achieved with classic surgery for hemorrhoidal disease show in the majority of cases that radiosurgery facilitates, accelerates and improves surgical procedures.

背景

在本文中，我们报告了我们之前关于射频（RF）在直肠学中的应用，特别是在痔疮治疗方面的研究结果。

方法

我们比较了射频黏膜下痔切除术（RSH）和传统的 Parks 痔切除术（CPH）（第 1 组）、射频开放式痔切除术（ROH）和 Milligan-Morgan 痔切除术（MMH）（第 2 组）、射频闭合式痔切除术（RCH）和 Ferguson 痔切除术（FH）（第 3 组）、联合痔放射性凝固术（CHR）和橡皮圈结扎术（RBL）（第 4 组）。在这项工作中，主要终点确定为评估手术后即刻和第一次排便时的疼痛程度、出血、手术时间、重返工作岗位的时间、失败发生率和患者满意度。

结果

第 1 组 - 与 Parks 技术相比，使用射频手术刀减少了平均手术时间（61.2 分钟，范围 50-75 与 37.4 分钟，范围 30-51；p<0.05）、术后第 1 天疼痛评分（5.9，范围 3-10，与 4.0，范围 1-10；p<0.05）、第 1 次排便时疼痛评分（5.7，范围 2-10，与 4.2，范围 1-8；p<0.05）和术后第 1 天疼痛评分（3.6，范围 1-9，与 2.8，范围 1-8；p<0.05）。第 2 组 - 结果表明这些技术之间存在实质性相似之处，但 RF 手术刀的手术时间缩短了 7 分钟（18.6 分钟，范围 16-21 与 25.55 分钟，范围 20-30；p<0.05）。第 3 组 - 接受 RF 治疗的患者手术时间明显缩短（23 分钟，范围 21-31 与 33 分钟，范围 24-35；p<0.01），术后第 1 天疼痛评分（VAS 评分 3.4+/-1.3 与 4.8+/-1.0；p<0.05）和第 1 次排便时疼痛评分（3.4+/-1.0 与 5.0+/-0.8；p<0.05）。第 4 组 - 该研究证实了这两种技术的有效性，但 CHR 似乎可以降低失败率。