van Tol Robin R, Bruijnen Marieke P A, Melenhorst Jarno, van Kuijk Sander M J, Stassen Laurents P S, Breukink Stéphanie O
Department of Surgery and Colorectal Surgery, Academic Hospital Maastricht, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands.
Int J Colorectal Dis. 2018 May;33(5):577-588. doi: 10.1007/s00384-018-3019-5. Epub 2018 Mar 15.
In this study, we describe current practices in the management of hemorrhoidal disease in the Netherlands.
A validated online survey was performed among Dutch surgeons and residents treating hemorrhoidal disease. Contact details were retrieved from the Dutch Association for Surgery resulting in 619 contacts. Only doctors who were treating hemorrhoidal disease regularly were asked to complete the questionnaire. The following items were assessed: initial treatment, recurrence, complications, and follow-up.
In total, 133 respondents completed the survey. Ninety percent of the respondents started with rubber band ligation (RBL) as the first treatment in low-grade hemorrhoidal disease. In case of recurrence, 64% of the respondents repeated RBL three times before switching to a more invasive treatment modality. In grade III hemorrhoidal disease, the respondents preferred more invasive techniques: a sutured hemorrhoidopexy was performed in 24%, Doppler-guided hemorrhoidal artery ligation (DG-HAL) in 9%, stapled hemorrhoidopexy in 19%, and the traditional hemorrhoidectomy in 31% of the patients, respectively. The majority of the respondents (39%) reported a mild complication in 5-10% of the patients. The most reported complication was pain. Nearly all the respondents (98%) reported a major complication in less than 5% of the patients. The majority of the patients (57%) were seen in outpatient clinics 6 weeks post-treatment.
This Dutch survey showed areas of common practice for primary treatment of hemorrhoidal disease. However, it also demonstrated varying practices regarding recurrent hemorrhoidal disease. Practical guidelines are required to support colorectal surgeons in the Netherlands.
在本研究中，我们描述了荷兰痔病管理的当前实践情况。
对荷兰治疗痔病的外科医生和住院医师进行了一项经过验证的在线调查。从荷兰外科协会获取联系方式，共得到619个联系人。仅邀请定期治疗痔病的医生填写问卷。评估了以下项目：初始治疗、复发、并发症和随访。
共有133名受访者完成了调查。90%的受访者在治疗轻度痔病时首先采用橡皮圈套扎术（RBL）。对于复发情况，64%的受访者在改用更具侵入性的治疗方式之前重复进行了3次RBL。在III度痔病患者中，受访者更倾向于采用更具侵入性的技术：分别有24%的患者接受了缝合痔固定术，9%的患者接受了多普勒引导下痔动脉结扎术（DG-HAL），19%的患者接受了吻合器痔固定术，31%的患者接受了传统痔切除术。大多数受访者（39%）报告称5%-10%的患者出现轻度并发症。最常报告的并发症是疼痛。几乎所有受访者（98%）报告称不到5%的患者出现严重并发症。大多数患者（57%）在治疗后6周在门诊接受复查。
这项荷兰的调查显示了痔病初级治疗的常见做法领域。然而，它也表明在复发性痔病的治疗方面存在不同做法。需要实用指南来支持荷兰的结直肠外科医生。
