Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.
Medical Vascular Disease Clinic Unit, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zrab012.
Arterial hyperflow to haemorrhoids has been implicated as a possible pathophysiological co-factor in haemorrhoidal disease. The purpose of this study was to investigate how transanal haemorrhoidal dearterialization (THD) can influence haemodynamic parameters at the level of the haemorrhoidal piles.
Patients with grade III haemorrhoids selected for THD between July and December 2018 were evaluated using endoanal ultrasonography and colour Doppler imaging at the level of internal haemorrhoids before and 1 year after the surgical procedure. Peak systolic velocity, pulsatility index, resistivity index, acceleration time, and end-diastolic velocity were measured, and preoperative and postoperative values compared. Symptom severity was measured using a symptom-based questionnaire (score range 0-20).
Of 21 patients treated, 17 completed the study. Compared with preoperative values, postoperative peak systolic velocity (mean(s.d.) 18.7(1.1) versus 10.3(0.4) cm/s; P < 0.05), pulsatility index (5.5(0.3) versus 2.8(0.4); P < 0.050), and resistivity index (1.0(0.2) versus 0.8(0.5); P < 0.050) decreased significantly, whereas acceleration time increased significantly (65.6(3.6) versus 83.3(4.7) cm/s2; P < 0.050); end-diastolic velocity did not change (1.9(0.2) versus 2.0(0.4); P = 0.753). Symptoms disappeared or had improved significantly in all patients by 1 year after surgery. The mean(s.d.) total symptom severity score decreased from 15.8(1.1) to 1.2(1.6) (P < 0.001).
THD affects the main haemodynamic parameters at the level of internal haemorrhoids and is associated with a decrease in arterial hyperflow.
动脉向痔的高血流已被认为是痔病的一种可能的病理生理协同因素。本研究的目的是探讨经肛门痔动脉结扎术（THD）如何影响痔内水平的血流动力学参数。
2018 年 7 月至 12 月间，选择行 THD 的 III 度痔患者，术前及术后 1 年，采用经肛门超声及彩色多普勒成像测量痔内水平的收缩期峰值速度、搏动指数、阻力指数、加速时间及舒张末期速度，并比较术前、术后值。采用基于症状的问卷（评分范围 0-20）评估症状严重程度。
21 例患者中，17 例完成研究。与术前相比，术后收缩期峰值速度（平均（标准差）18.7（1.1）比 10.3（0.4）cm/s；P<0.05）、搏动指数（5.5（0.3）比 2.8（0.4）；P<0.050）和阻力指数（1.0（0.2）比 0.8（0.5）；P<0.050）显著降低，而加速时间显著增加（65.6（3.6）比 83.3（4.7）cm/s2；P<0.050）；舒张末期速度无变化（1.9（0.2）比 2.0（0.4）；P=0.753）。术后 1 年，所有患者的症状均消失或明显改善。总的症状严重程度评分从 15.8（1.1）降至 1.2（1.6）（P<0.001）。
THD 影响痔内水平的主要血流动力学参数，并与动脉高血流减少相关。
