Jain Anshini, Lew Chen, Aksakal Gamze, Hiscock Richard, Mirbagheri Naseem
Department of Surgery, Epworth HealthCare, Melbourne, VIC, Australia.
Department of Surgery, Eastern Health, Melbourne, VIC, Australia.
Ann Coloproctol. 2024 Feb;40(1):52-61. doi: 10.3393/ac.2022.00164.0023. Epub 2022 May 19.
Traditional therapeutic approaches to the surgical management of hemorrhoid disease such as hemorrhoidectomies are plagued with severe postoperative pain and protracted recovery. Our pilot study aims to the laser hemorrhoidoplasty (LH) patients with symptomatic hemorrhoid disease that have failed conservative management for the first time in an Australian population.
Thirty patients were prospectively enrolled to undergo LH. Postoperative pain, time to return to function, and quality of life (QoL) were determined through the Hemorrhoid Disease Symptom Score and Short Health Scale adapted for hemorrhoidal disease and compared to a historical group of 43 patients who underwent a Milligan-Morgan hemorrhoidectomy by the same surgeon at 3, 6, and 12 months.
The LH group had significantly lower mean predicted pain scores on days 1 and 2 and lower defecation pain scores and lower opioid analgesia use on days 1, 2, 3, and 4. The median time to return to normal function was significantly lower in the LH group (2 days vs. 9 days, P<0.001). Similarly, the median days to return to the workplace was significantly lower in the LH group (6 days vs. 13 days, P=0.007). During long-term follow-up (12 months), hemorrhoid symptoms and all QoL measures were significantly improved, especially among those with grade II to III disease.
This pilot study demonstrates low pain scores with this revivified procedure in an Australian population, indicating possible expansion of the therapeutic options available for this common condition. Further head-to-head studies comparing LH to other hemorrhoid therapies are required to further determine the most efficacious therapeutic approach.
传统的痔病手术治疗方法,如痔切除术,存在严重的术后疼痛和恢复时间长的问题。我们的初步研究旨在首次对澳大利亚有症状痔病患者进行激光痔成形术(LH),这些患者保守治疗失败。
前瞻性纳入30例患者接受LH治疗。通过痔病症状评分和适用于痔病的简短健康量表来确定术后疼痛、恢复功能的时间和生活质量(QoL),并与同一外科医生进行Milligan-Morgan痔切除术的43例历史对照组患者在3、6和12个月时进行比较。
LH组在第1天和第2天的平均预测疼痛评分显著更低,在第1、2、3和4天的排便疼痛评分更低,阿片类镇痛药物使用更少。LH组恢复正常功能的中位时间显著更短(2天对9天,P<0.001)。同样,LH组返回工作场所的中位天数显著更短(6天对13天,P=0.007)。在长期随访(12个月)期间,痔症状和所有生活质量指标均显著改善,尤其是在II至III级疾病患者中。
这项初步研究表明,在澳大利亚人群中,这种新的手术方法疼痛评分较低,这表明对于这种常见疾病,治疗选择可能会扩大。需要进一步进行LH与其他痔治疗方法的直接比较研究,以进一步确定最有效的治疗方法。