Peker Kemal, Inal Abdullah, Güllü Huriye, Gül Düriye, Sahin Murat, Ozcan Ayca Dumanli, Kılıç Kemal
Erzincan University Department of General Surgery, Erzincan, Turkey.
Erzincan University Department of Anesthesiology & Reanimation, Erzincan, Turkey.
Iran Red Crescent Med J. 2013 Jun;15(6):488-96. doi: 10.5812/ircmj.10180. Epub 2013 Jun 5.
Haemorrhoids are cushions of submucosal vascular tissue located in the anal canal starting just distal to the dentate line. Haemorrhoidal disease is a common anorectal disorder which has symptoms of bleeding, prolapse, pain, thrombosis, mucus discharge, and pruritus. Haemorrhoidectomy is one of most frequently performed anorectal operation worldwide.
The aim of this study was to compare the effectiveness of the LigaSure tissue sealing device, Harmonic Scalpel and conventional MM open haemorrhoidectomy.
Sixty-nine patients with newly diagnosed symptomatic grade three or grade four haemorrhoidal disease, from July 2011 to December 2011 were recruited for the study. Patients were prospectively randomized to LigaSure, Harmonic Scalpel and conventional haemorrhoidectomy. Patients were evaluated on the basis of the mean operative time, postoperative pain, day of discharge, early and late complications.
Each group has twenty-three patients. Ten (14.5 %) were female and fifty-nine (85.5 %) were male. Mean age were 44.5 ± 10.8 for LigaSure group, 39.5±14.4 for Harmonic Scalpel group and 39.8 ± 13.6 for conventional haemorrhoidectomy group. Mean operative time was 12.6 ± 2.9 for LigaSure group, 12.6 ± 2.5 for Harmonic Scalpel group and 22.3 ± 4.5 for conventional haemorrhoidectomy group. Postoperative pain and required analgesic dose were significantly lower for conventional haemorrhoidectomy. Wound healing was also more rapid in conventional haemorrhoidectomy than both LigaSure and Harmonic Scalpel.
Lateral heat dissipation of energy based cautery such as Harmonel Scalpel and LigaSure is considerably high when compared with conventional methods. More thermal damage which is generated on tissue seems to be the reason for increased degree of postoperative pain and delay in wound healing.
痔疮是位于肛管黏膜下血管组织的垫，起于齿状线远侧。痔病是一种常见的肛肠疾病，有出血、脱垂、疼痛、血栓形成、黏液排出和瘙痒等症状。痔切除术是全球最常施行的肛肠手术之一。
本研究的目的是比较LigaSure组织封闭装置、超声刀和传统Milligan-Morgan开放式痔切除术的有效性。
2011年7月至2011年12月，69例新诊断的有症状的Ⅲ度或Ⅳ度痔病患者被纳入本研究。患者被前瞻性随机分为LigaSure组、超声刀组和传统痔切除术组。根据平均手术时间、术后疼痛、出院日期、早期和晚期并发症对患者进行评估。
每组有23例患者。10例（14.5%）为女性，59例（85.5%）为男性。LigaSure组平均年龄为44.5±10.8岁，超声刀组为39.5±14.4岁，传统痔切除术组为39.8±13.6岁。LigaSure组平均手术时间为12.6±2.9分钟，超声刀组为12.6±2.5分钟，传统痔切除术组为22.3±4.5分钟。传统痔切除术的术后疼痛和所需镇痛剂量明显更低。传统痔切除术的伤口愈合也比LigaSure和超声刀都更快。
与传统方法相比，诸如超声刀和LigaSure等基于能量侧向散热的电灼术热量散失相当高。组织上产生的更多热损伤似乎是术后疼痛程度增加和伤口愈合延迟的原因。
