Functional and Oncologic Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
Interdepartmental Research Unit for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy.
Colorectal Dis. 2018 Dec;20(12):1117-1124. doi: 10.1111/codi.14339. Epub 2018 Aug 16.
The management of haemorrhoids has changed significantly in the last two decades as a result of new insights into their pathophysiology and the availability of new surgical devices. The aim of this survey was to evaluate changes in the management of haemorrhoids in Italy over the last 17 years.
An electronic database which recorded details of management relating to the severity of haemorrhoids between 2000 and 2016 was obtained from 18 of 34 colorectal surgeons who were invited to participate.
A total of 32 458 patients were treated for haemorrhoids by 18 expert coloproctologists during a 17-year period. Patients were classified as Grade II (7542, 23.2%), Grade III(15 360, 47.3%) and Grade IV (9556, 29.4%). Grade II haemorrhoids were treated with rubber band ligation in over 90% of the cases, and patients with Grade IV had a Milligan-Morgan (MM) haemorrhoidectomy in over 90% of the cases. In Grade III, the use of stapled haemorrhoidopexy progressively decreased from 30% to 35% (between 2000 and 2007) to 5% of the cases. Meanwhile, commencing from 2006 the use of Doppler-guided haemorrhoid artery ligation (DGHAL) with mucopexy increased progressively from 6% to 24%. Over the years, the percentage of MM haemorrhoidectomy remained consistent at between 65% and 70% of the cases.
Relevant changes in the surgical choice of haemorrhoid treatment have occurred in Italy over the last 17 years. MM haemorrhoidectomy remains the most frequently performed procedure for Grade III haemorrhoids. Stapled haemorrhoidopexy has become much less popular in contrast to DGHAL with mucopexy which is being performed much more frequently.
由于对痔的病理生理学有了新的认识，以及新的手术设备的出现，痔的治疗在过去二十年发生了重大变化。本研究旨在评估意大利过去 17 年来痔治疗方法的变化。
从 34 位受邀参与的肛肠外科医生中，获得了一个电子数据库，该数据库记录了 2000 年至 2016 年期间与痔严重程度相关的治疗细节。
18 位肛肠专家在 17 年期间共治疗了 32458 例痔患者。患者被分为 II 级（7542 例，23.2%）、III 级（15360 例，47.3%）和 IV 级（9556 例，29.4%）。90%以上的 II 级痔患者采用橡皮圈结扎治疗，90%以上的 IV 级痔患者采用Milligan-Morgan（MM）痔切除术治疗。在 III 级痔中，吻合器痔上黏膜环切术的使用率从 2000 年至 2007 年的 30%至 35%逐渐下降至 5%。与此同时，自 2006 年以来，多普勒引导下痔动脉结扎术（DGHAL）联合黏膜固定术的使用率从 6%逐渐上升至 24%。多年来，MM 痔切除术的比例一直保持在 65%至 70%的病例。
过去 17 年来，意大利痔的手术治疗选择发生了变化。MM 痔切除术仍然是治疗 III 级痔最常用的方法。吻合器痔上黏膜环切术的应用明显减少，而多普勒引导下痔动脉结扎术联合黏膜固定术的应用则明显增多。
