Béliard A, Labbé F, de Faucal D, Fabreguette J-M, Pouderoux P, Borie F
Service de chirurgie digestive, CHU Carémeau, place du Professeur-Debré, 30029 Nîmes, France.
Service de chirurgie viscérale, CHG de Carcassonne, 11000 Carcassonne, France.
J Visc Surg. 2014 Sep;151(4):257-62. doi: 10.1016/j.jviscsurg.2014.03.009. Epub 2014 Apr 13.
The aim of this study was to compare the efficacy between stapled hemorrhoidopexy (Longo technique) and transanal hemorrhoidal artery ligation with mucopexy (THDm) in the treatment of hemorrhoidal disease.
From June 2009 to January 2011, 81 patients having grade II or III hemorrhoidal disease underwent prospective evaluation followed by surgery at two centers (27 Longo and 54 THDm). Symptoms (bleeding, tenesmus, prolapse, fecal incontinence, pain) and the satisfaction score were compared on the first post-operative day and at 1, 6, 12, and 24 months thereafter. The follow-up was 24 months.
There was no difference in mean length of stay. One complication (recto-vaginal fistula) was observed after Longo. The prolapse score was significantly lower after THDm than after Longo on the first post-operative day (P < 0.0015). Bleeding score after THDm was significantly lower on the first post-operative day (P = 0.04), but higher thereafter (P = 0.03 and P = 0.04). Tenesmus score after THDm was significantly lower for the first three months (P < 0.06 and 0.001). On the first post-operative day and at one month, the visual analog pain score was significantly lower after THDm than that after Longo (P < 0.0003 et P < 0.01). On the first post-operative day and at one month, the satisfaction score was higher after THDm than after Longo (P < 0.001).
THDm was safe and effective. Short-term outcomes after THDm were better than after Longo but long-term results seemed to be similar.
本研究旨在比较吻合器痔上黏膜环切术（龙氏技术）与经肛门痔动脉结扎术联合黏膜固定术（THDm）治疗痔病的疗效。
2009年6月至2011年1月，81例Ⅱ或Ⅲ度痔病患者在两个中心接受了前瞻性评估并随后接受手术（27例行龙氏技术，54例行THDm）。比较术后第1天以及此后1、6、12和24个月时的症状（出血、里急后重、脱垂、大便失禁、疼痛）和满意度评分。随访24个月。
平均住院时间无差异。龙氏技术术后观察到1例并发症（直肠阴道瘘）。术后第1天，THDm术后的脱垂评分显著低于龙氏技术术后（P < 0.0015）。THDm术后第1天的出血评分显著更低（P = 0.04），但此后更高（P = 0.03和P = 0.04）。THDm术后前三个月的里急后重评分显著更低（P < 0.06和0.001）。术后第1天和1个月时，THDm术后的视觉模拟疼痛评分显著低于龙氏技术术后（P < 0.0003和P < 0.01）。术后第1天和1个月时，THDm术后的满意度评分高于龙氏技术术后（P < 0.001）。
THDm安全有效。THDm的短期疗效优于龙氏技术，但长期结果似乎相似。
