美國(guó)痔診治指南(20xx版)-資料下載頁(yè)
2025-08-05 16:05本頁(yè)面
【正文】 一項(xiàng)最近的薈萃分析顯示，與傳統(tǒng)痔切除術(shù)相比，接受痔釘合術(shù)的患者長(zhǎng)期隨訪復(fù)發(fā)率更高 [45] ；另一項(xiàng)薈萃分析（包括 1077位患者）顯示，痔釘合術(shù)與傳統(tǒng)痔切除術(shù)結(jié)果相似 [45] ? 更新近的 Cochrane系統(tǒng)評(píng)價(jià)（包括 6項(xiàng)隨訪超過(guò)均一年的隨機(jī)試驗(yàn)，共 628位患者）顯示，在疼痛、瘙癢和大便急迫方面，痔釘合術(shù)和傳統(tǒng)痔切除術(shù)之間無(wú)明顯差異，但是痔釘合術(shù)的長(zhǎng)期復(fù)發(fā)率更高 [46] [45] Nisar PJ, Acheson AG, Neal KR, Scholenfield JH. Stapled hemorrhoidopexy paredwith conventional hemorrhoidectomy:systematic review of randomized controlled trials. Dis Colon Rectum. 2022。47:1837– 1845. [46] Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associatedwith a higher longterm recurrence rate of internal hemorrhoids pared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2022。50:1297– 1305.. 手術(shù)治療 —痔釘合術(shù)（一） ? 盡管痔釘合術(shù)有幾種獨(dú)有的并發(fā)癥（如直腸陰道瘺、吻合口出血），但總的并發(fā)癥發(fā)生率與傳統(tǒng)痔切除術(shù)相似 ? 一項(xiàng)薈萃分析（包括 2022位患者 )顯示，痔釘合術(shù)的并發(fā)癥發(fā)生率為 %，而傳統(tǒng)痔切除術(shù)為 % [47] ? 盡管小部分?jǐn)?shù)據(jù)顯示取得成功 [48]，但總體來(lái)說(shuō)，痔釘合術(shù)對(duì)大的外痔或血栓性外痔是無(wú)效的 [47] Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2022。50:878– 892. [48] Wong JC, Chung CC, Yau KK, et al. Stapled technique for acute thrombosed hemorrhoids: a randomized, controlled trial with longterm results. Dis Colon Rectum. 2022。51:397– 403. 手術(shù)治療 —痔釘合術(shù)（二） ? 即使用肛門(mén)鏡式的多普勒探頭確認(rèn)每個(gè)痔核的動(dòng)脈位臵，并在其引導(dǎo)下將之結(jié)扎 ? 其潛在的優(yōu)勢(shì)是不切除組織，疼痛可能更小 ? 一些前瞻性的研究顯示，對(duì)于 90%的患者取得了較好的止血效果，復(fù)發(fā)率為 10%~15% [4951] [49] Ratto C,Donisi L, Parello A, Litta F,Doglietto GB. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon 。53:803– 811. [50] Felice C, Privitera A, Ellul E, Klaumann M. Dopplerguided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum. 2022。48:2090– 2093. [51] Faucheron JL, Gangner Y. Dopplerguided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and threeyear followup results in 100 consecutive patients. Dis Colon Rectum. 2022。 51: 945– 949. 手術(shù)治療 —多普勒引導(dǎo)下的痔動(dòng)脈結(jié)扎術(shù)（一） ? 最近的系統(tǒng)評(píng)價(jià)（包括 17項(xiàng)試驗(yàn)、共 1996位患者）顯示，總的復(fù)發(fā)率為：脫垂 9%，出血 8%，便時(shí)疼痛 5%；隨訪大于 1年的患者復(fù)發(fā)率為：脫垂11%，出血 10%，便時(shí)疼痛 9% ? 筆者發(fā)現(xiàn)， Ⅳ 期痔復(fù)發(fā)率更高，因此，推薦此法用于 Ⅱ 、 Ⅲ 期痔 [52] ? 目前，對(duì)此方法的推薦仍缺乏研究證據(jù)，今后應(yīng)致力于普勒手術(shù)及多普勒與其他術(shù)式相比較的更大規(guī)模的長(zhǎng)期隨訪研究 [53,54] [52] Giordano P, Overton J, Madeddu F, Zaman S, Gravante hemorrhoidal dearterialization: a systematic Colon Rectum. 2022。52:1665– 1671. [53] Infantino A, Bellomo R, Dal Monte PP, et al. Transanal haemorrhoidal artery echo Doppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study [published online ahead of print April 15, 2022].Colorectal Dis. DOI: [54] Dal Monte PP, Tagariello C, Sarago, et al. Transanal haemorrhoidal dearterialisation nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol. 2022。11:333– 338. 手術(shù)治療 —多普勒引導(dǎo)下的痔動(dòng)脈結(jié)扎術(shù)（二）
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