Ng Kheng-Seong, Holzgang Melanie, Young Christopher
Institute of Academic Surgery, University of Sydney, Sydney, Australia.
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Coloproctol. 2020 Jun;36(3):133-147. doi: 10.3393/ac.2020.05.04. Epub 2020 Jun 30.
The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR "Hemorrhoid"[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel "walk-in-walk-out" techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.
虽然有多种治疗选择且有不同的证据支持，但患者合理地要求采用个性化的治疗方法。关于有望减少疼痛的新型手术技术的证据一直存在矛盾。我们回顾了目前针对不同痔疮分级患者的管理选择的证据。利用MEDLINE/PubMed、Embase和Cochrane数据库（2019年5月31日）对英文文献进行了综述。使用了搜索词（痔疮或痔或痔或痔或“痔”[医学主题词]）。一度和二度痔疮仍采用保守治疗。易于重复且成本效益高的橡皮圈套扎术是治疗轻度痔疮的首选方法；注射硬化疗法的长期效果仍然不佳。传统痔切除术（弗格森/米利根 - 摩根/结扎术痔切除术）在三度和四度痔疮的治疗中仍有其作用，复发率最低；然而，痔切除术后疼痛是个问题。吻合器痔上黏膜环切术恢复较快，尽管代价是复发率较高和可能出现严重并发症。经肛门痔动脉结扎术被宣传为非切除性且侵入性较小，但最近的HubBLe试验对其在痔疮治疗中的整体地位提出了质疑。新型“即入即出”技术，如射频消融或激光治疗，需要进一步评估以确定它们在现代痔疮治疗中的作用。痔疮有众多治疗选择，每种都有其自身的证据基础。新技术有望减少疼痛，但复发率仍然是个问题。仍在寻求长期疗效、术后疼痛最小化和保留肛门直肠功能之间的平衡。
