A Randomized Trial of Transanal Hemorrhoidal Dearterialization With Anopexy Compared With Open Hemorrhoidectomy in the Treatment of Hemorrhoids
A Randomized Trial of Transanal Hemorrhoidal Dearterialization With Anopexy Compared With Open Hemorrhoidectomy in the Treatment of Hemorrhoids
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DOI：
10.1097/dcr.0b013e31827a8567
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发表时间：
2013-04-01
影响因子：
3.9
通讯作者：
Lenander, Claes E.
中科院分区：
文献类型：
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作者：
Elmer, Solveig E.;Nygren, Jonas O.;Lenander, Claes E.
背景：在过去的十年中，痔手术中的多普勒引导变得越来越频繁。该方法主要在非随机试验中研究。缺乏随机对照试验的数据。目的：本研究的目的是比较早期和中期的结果，经肛门痔去动脉化与肛门固定术开放痔切除术。设计，设置，患者和干预：40例2 ~ 3级痔患者随机接受经肛门痔动脉化术和肛门固定术A组（n = 20）和开放性痔切除术（B组，n = 20）。在术后前2周使用日记。一个自我报告的症状问卷进行回答，并在术前进行临床检查，2至4个月后，1 year.MAIN观察指标：主要结果的措施是术后pain.Results：术后疼痛峰值是在第一周内，A组低于组B（p < 0.05），而没有显着差异的整体疼痛。在A组中，更多的患者表达了正常的幸福感（p = 0.045）。疼痛、出血和需要手动复位痔的情况在1年后两组均有所改善（p < 0.05）。在早期随访时，两种方法后的污染都有所减少。1年后，只有开放式痔切除术后污物才显著减少。两种方法1年后痔的分级均显著降低，但A组中有更多患者存在残留2级痔的趋势（p = 0.06）。限制：无盲法，样本量小，随访仅1年。调查问卷没有validated.CONCLUSION：经肛门痔动脉化与肛门固定术和开放式痔切除术之间的术后疼痛差异可能小于预期的基础上，以前的文献。
BACKGROUND: Doppler guidance in hemorrhoidal surgery has become more frequent during the past decade. The method is mainly studied in nonrandomized trials. Data from randomized controlled trials are lacking.OBJECTIVE: The aim of this study was to compare early and midterm results of transanal hemorrhoidal dearterialization with anopexy to open hemorrhoidectomy.DESIGN, SETTINGS, PATIENTS, AND INTERVENTIONS: Forty patients with grade 2 to 3 hemorrhoids were randomly assigned to transanal hemorrhoidal dearterialization with anopexy (group A, n = 20) or open hemorrhoidectomy (group B, n = 20). A diary was used during the first 2 postoperative weeks. A self-reported symptom questionnaire was answered, and a clinical examination was performed preoperatively, after 2 to 4 months, and after 1 year.MAIN OUTCOME MEASURE: The main outcome measure was postoperative pain.RESULTS: Postoperative peak pain was lower in group A during the first week than in group B (p < 0.05), whereas no difference in overall pain was noted. More patients expressed normal well-being in group A (p = 0.045). Pain, bleeding, and the need for manual reduction of the hemorrhoids were all improved in both groups after 1 year (p < 0.05). Soiling had decreased after both methods at early follow-up. After 1 year, soiling was significantly decreased only after open hemorrhoidectomy. The grade of hemorrhoids was significantly reduced after 1 year for both methods, but there was a trend to more patients with remaining grade 2 hemorrhoids in group A (p = 0.06).LIMITATIONS: There was no blinding, the sample size was small, and follow-up was for only 1 year. The questionnaire was not validated.CONCLUSION: The difference in postoperative pain between transanal hemorrhoidal dearterialization with anopexy and open hemorrhoidectomy may be less than expected based on previous literature.