Scheyer M, Antonietti E, Rollinger G, Lancee S, Pokorny H
Department of General Surgery, State Hospital, 6700, Bludenz, Vorarlberg, Austria.
Tech Coloproctol. 2015 Jan;19(1):5-9. doi: 10.1007/s10151-014-1246-5. Epub 2014 Nov 19.
Rectoanal repair (RAR), which combines doppler-guided hemorrhoidal artery ligation (HAL) and mucopexy via lifting of the hemorrhoidal prolapse, offers a minimally invasive alternative to conventional hemorrhoidectomy.
Patients with grade II hemorrhoids were treated with HAL, and patients with grade III and IV hemorrhoids were treated with the RAR procedure by two surgeons. Postoperative follow-up was performed clinically and by proctoscopy after 8 weeks routinely, and long-term follow-up was performed using a standardized postal questionnaire.
The overall complication rate was 29% (n = 118). After short-term follow-up, 26% (n = 106) of patients reported recurrent or persistent prolapsing piles, while 21% (n = 86) of patients had recurrent bleeding. After long-term follow-up, 24% (n = 98) of patients reported prolapsing piles, 3% (n = 12) bleeding, 3% (n = 12) pruritus, and 2% (n = 8) anal pain, while 20% (n = 82) complained of persistent mixed symptoms.
HAL and RAR provide prolonged relief for patients with hemorrhoidal disease whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as an initial indication.
直肠肛管修复术（RAR）结合了多普勒引导下的痔动脉结扎术（HAL）以及通过提起痔脱垂进行的黏膜固定术，为传统痔切除术提供了一种微创替代方案。
II度痔患者接受HAL治疗，III度和IV度痔患者由两名外科医生进行RAR手术。术后8周常规进行临床及直肠镜随访，长期随访采用标准化邮寄问卷。
总体并发症发生率为29%（n = 118）。短期随访后，26%（n = 106）的患者报告有复发性或持续性痔脱垂，21%（n = 86）的患者有复发性出血。长期随访后，24%（n = 98）的患者报告有痔脱垂，3%（n = 12）有出血，3%（n = 12）有瘙痒，2%（n = 8）有肛门疼痛，20%（n = 82）抱怨有持续性混合症状。
HAL和RAR能为以出血、瘙痒和疼痛为主要症状的痔病患者提供长期缓解，但对于以脱垂为初始表现的患者则不然。
