Ratto C, Parello A, Veronese E, Cudazzo E, D'Agostino E, Pagano C, Cavazzoni E, Brugnano L, Litta F
Proctology Unit, Department of Surgical Sciences, Catholic University, Rome, Italy.
Colorectal Dis. 2015 Jan;17(1):O10-9. doi: 10.1111/codi.12779.
This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome.
Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analyses of the potential predictive factors for failure were performed.
The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler-guided dearterialization were associated with a better outcome.
THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.
这项多中心研究基于有史以来最大的患者群体，旨在评估多普勒引导下经肛门痔动脉结扎术（THD多普勒）治疗有症状痔的疗效，并确定预测中期有效结局失败的因素。
803例患有II级（137例，17.1%）、III级（548例，68.2%）和IV级（118例，14.7%）有症状痔病的患者接受了THD多普勒治疗，痔脱垂患者同时行直肠黏膜固定术。通过专门设计的症状问卷和评分系统对疾病进行评估。对失败的潜在预测因素进行单因素和多因素分析。
发病率为18.0%，主要表现为疼痛或里急后重（106例患者，13.0%）。7例患者（0.9%）发生需要手术止血的急性出血。未发生严重或危及生命的并发症。平均随访11.1±9.2个月后，总成功率为90.7%（728例患者），痔脱垂、出血及两种症状复发的患者分别为51例（6.3%）、19例（2.4%）和5例（0.6%）。47例接受再次手术的患者中有16例行传统痔切除术。评分各领域所有症状均有显著改善（P<0.0001）。多因素分析显示，无并发症及进行远端多普勒引导下动脉结扎与更好的结局相关。
THD多普勒是治疗痔病的一种安全有效的方法。如果采用该技术，准确的远端多普勒引导下动脉结扎和针对性的黏膜固定术对于控制和减轻症状是必不可少的。
