多普勒引导下经肛门痔动脉结扎术与传统痔切除术治疗痔疮的早期及长期术后结果
Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids - early and long-term postoperative results.
作者信息
Popov V, Yonkov A, Arabadzhieva E, Zhivkov E, Bonev S, Bulanov D, Tasev V, Korukov G, Simonova L, Kandilarov N, Taseva A, Dimitrova V
机构信息
Department of General and Hepato-pancreatic Surgery, University Hospital "Alexandrovska", 1 Georgi Sofiiski Str, 1431, Sofia, Bulgaria.
Medical University-Sofia, 15 Acad. I. E. Geshov Bul, 1431, Sofia, Bulgaria.
出版信息
BMC Surg. 2019 Jan 10;19(1):4. doi: 10.1186/s12893-019-0469-9.
BACKGROUND
A variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results.
METHODS
The conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients' satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0.
RESULTS
There was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients' satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802).
CONCLUSIONS
Doppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients' selection.
TRIAL REGISTRATION
(retrospectively registered) researchregistry 3090 .
背景
已提出多种治疗痔疮的有效方法。近年来，比较经肛门痔动脉结扎术（THD）和传统痔切除术（CH）的研究越来越多，但大多数研究的重点是术后早期结果。关于长期疗效的数据仍然有限。我们旨在比较多普勒引导下的THD和CH在术后早期和长期的疗效。
方法
这项前瞻性研究纳入了287例在2010年11月至2015年12月期间接受CH（167例）或多普勒引导下带肌固定术的THD（120例）的患者。获取了有关痔疮分期、人口统计学数据、主要症状、并发症、住院时间、术后疼痛、患者满意度和随访等信息。采用SPSS 19.0进行统计检验。
结果
根据性别、平均年龄、术前脱垂、疼痛和瘙痒、痔疮分期及术后并发症，研究组之间无显著差异。THD组术前出血更频繁（p = 0.002）。CH组和THD组在第1、2和7天的平均视觉模拟量表（VAS）疼痛评分分别为7.01对5.03、5.07对2.98、2.39对0.57（p = 0.000）。实际上，第30天的VAS和第18个月的患者满意度无差异。平均住院时间CH组为5.13天，THD组为3.38天，p = 0.000。术后随访时间为18至78个月（平均46±16个月）。在此阶段，CH组有5例患者（2.99%）因复发需要再次手术。THD组有3例患者（2.5%），均为IV度痔疮，接受了额外的手术（p = 0.802）。
结论
多普勒引导下的THD似乎是一种治疗痔疮的有效且安全的选择，与CH相比，术后疼痛较轻，长期疗效良好且相似。对于晚期痔疮，多普勒引导下的THD可能是一种有价值的替代方法，但需要对患者进行选择。
试验注册
（回顾性注册）researchregistry 3090 。
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