Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain.
Tech Coloproctol. 2017 May;21(5):337-344. doi: 10.1007/s10151-017-1620-1. Epub 2017 Apr 27.
Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy (Doppler-guided THD) seems to be associated with better short-term outcomes than conventional hemorrhoidectomy, but there are little data about long-term recurrence. The aim of this study was to compare Doppler-guided THD for grade III-IV hemorrhoids with conventional hemorrhoidectomy with regard to long-term postoperative morbidity and recurrence.
This was a single-center longitudinal and comparative study of a cohort of patients who underwent either distal Doppler-guided THD with low ligation of the hemorrhoidal artery and mucopexy or conventional excisional hemorrhoidectomy (Milligan and Morgan or Ferguson) for grade III and IV hemorrhoids. Short- and long-term postoperative morbidity was recorded. Severity of hemorrhoid symptoms (bleeding, prolapse, manual reduction, discomfort or pain and impact on quality of life) and fecal continence status (Vaizey score) were evaluated before surgery and at minimum of 1 year after surgery.
Eighty-three patients were included in the study. Forty-nine patients (59%) underwent Doppler-guided THD, and 34 (41%) patients underwent conventional hemorrhoidectomy. The 30-day postoperative surgical morbidity was 26.5% in the Doppler-guided THD group and 8.82% in the conventional hemorrhoidectomy group (p = 0.085). No significant differences between the groups were observed in terms of persistence of bleeding, prolapse, need for manual reduction in prolapse and pain. One (2%) patient in the THD group and 2 (5.4%) patients in the conventional hemorrhoidectomy group needed further surgical procedures. Minor fecal incontinence occurred only after conventional hemorrhoidectomy in 2 (5.4%) patients.
Our results showed that Doppler-guided THD is not inferior to conventional excisional hemorrhoidectomy for advanced hemorrhoidal disease in terms of postoperative complications and long-term recurrence of symptoms.
与传统痔切除术相比，经肛门痔动脉阻断术（Doppler-guided THD）似乎与更好的短期结果相关，但长期复发的数据较少。本研究旨在比较多普勒引导 THD 治疗 III-IV 度痔与传统痔切除术在长期术后发病率和复发率方面的差异。
这是一项对接受多普勒引导 THD（低位结扎痔动脉和黏膜固定术）或传统切除术（Milligan 和 Morgan 或 Ferguson）治疗 III-IV 度痔的患者进行的单中心纵向和比较研究。记录短期和长期术后发病率。在术前和术后至少 1 年，评估痔症状严重程度（出血、脱垂、手动复位、不适或疼痛以及对生活质量的影响）和粪便控制状态（Vaizey 评分）。
研究共纳入 83 例患者。49 例（59%）患者接受多普勒引导 THD，34 例（41%）患者接受传统痔切除术。多普勒引导 THD 组的 30 天术后手术发病率为 26.5%，传统痔切除术组为 8.82%（p=0.085）。两组在出血、脱垂、脱垂手动复位和疼痛的持续存在方面无显著差异。THD 组有 1 例（2%）患者和传统痔切除术组有 2 例（5.4%）患者需要进一步手术。只有在接受传统痔切除术的 2 例（5.4%）患者中出现轻微的粪便失禁。
我们的结果表明，在术后并发症和症状长期复发方面，多普勒引导 THD 并不逊于传统的痔切除术治疗重度痔病。
