asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2018-3-4-77-82asurgery-126Research ArticleПРОКТОЛОГИЯPROCTOLOGYВозможности малоинвазивного лечения геморроидальной болезниPossibilities of minimally invasive treatments of hemorrhoidal diseaseАбрицоваМ. В.AbritsovaM. V.

Абрицова Марьяна Владимировна – кандидат медицинских наук, руководитель колопроктологической службы

Москва

ООО «Первая Хирургия»РоссияFirst Surgery LLCRussian Federation20180412201803-47782Copyright © Абрицова М.В., 20182018Абрицова М.В.Abritsova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/126

В статье представлены результаты хирургического лечения пациентов с 3 и 4 стадиями геморроя, с периодом наблюдения 45 дней, целью которого является улучшение результатов хирургического лечения данной категории больных. В качестве хирургического метода лечения выполнялась допплероконтролируемая дезартеризация внутренних геморроидальных узлов с мукопексией (ДДМ) (1-я группа) и геморроидэктомия гармоническим скальпелем (ГГС) (2-я группа). У оперированных пациентов все необходимые исследования проводили по принципу «per protocol». Дизайн исследования: одноцентровое контролируемое рандомизированное проспективное. Было отмечена эффективность ДДМ, сопоставимая с таковой геморроидэктомии (ГЭ), позволяющая статистически достоверно сократить длительность операции (ДДМ – 17,9 ± 6,1 мин, ГЭ – 34,5 ± 10,1 мин (р < 0,01)), уменьшить уровень боли в послеоперационном периоде (ДДМ – в среднем 2,5 балла, ГЭ – 4,8 балла (р < 0,01)), снизить частоту приема наркотических анальгетиков (ДДМ – в среднем 1,3 дозы, ГЭ – в среднем 6,1 дозы (р < 0,01)) и сократить период нетрудоспособности (ДДМ – 14,4 ± 5,2 дня, ГЭ – 30,3 ± 5,4 дня (р < 0,01)) пациентов с 3 и 4 стадиями заболевания.

The article presents the results of surgical treatment of patients with stages III to IV hemorrhoids followed by an observation period of 45 days, which is designed to improve the results of surgical treatment of this category of patients. The surgical treatment methods included doppler-guided transanal hemorrhoiddearterialization with mucopexy (DDM) (Group I) and harmonic scalpel hemorrhoidectomy (HSH) (Group II). Operated patients underwent all necessary examinations according to the “per protocol” principle. Study Design: single-center controlled randomized prospective. The effectiveness of DDM was comparable to that of hemorrhoidectomy (HE), which made it possible to significantly reduce the duration of the operation (DDM 17.9 ± 6.1 min, GE 34.5 ± 10.1 min (p <0.01) ), reduce the level of pain in the postoperative period (DDM an average of 2.5 points, HE 4.8 points (p <0.01)), reduce the frequency of narcotic analgesics (DDM an average of 1.3 doses, HE an average of 6.1 doses (p <0.01)) and shorten the period of disability (DDM 14.4 ± 5.2 days, HE 30.3 ± 5.4 days (p <0.01)) patients with stages III to IV disease.

геморройлечение геморроясклерозированиелигирование латексными кольцамидезартеризациядезартеризация с мукопексиейгеморроидэктомиямалоинвазивные методы лечениякеторолакhemorrhoidstreatment of hemorrhoidssclerotherapyrubber band ligationdearterizationdearterization with mupopexyhemorrhoidectomyminimally invasive treatmentsketorolacReferencesШелыгин Ю.А. Клинические рекомендации. Колопроктология. М.: ГЭОТАР-Медиа, 2015: 526.Shelygin YuA. Clinical guidelines. Coloproctology. M.: GEOTAR-Media, 2015: 526Altomare DF, Roveran A, Pecorella G, Gaj F, Stortini E. The treatment of hemorrhoids: guidelines of the Italian Society of Colo-Rectal Surgery. Tech Coloproctol, 2006, 10: 181-186.Altomare DF, Roveran A, Pecorella G, Gaj F, Stortini E. The treatment of hemorrhoids: guidelines of the Italian Society of Colo-Rectal Surgery. Tech Coloproctol, 2006, 10: 181-186.Rivadeneira DE, Steele SR, Ternent C, Chalasani S. Practice Parameters for the Management of Hemorrhoids (Revised 2010). The Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum, 2011, 54(9): 1059-1064.Rivadeneira DE, Steele SR, Ternent C, Chalasani S. Practice Parameters for the Management of Hemorrhoids (Revised 2010). The Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum, 2011, 54(9): 1059-1064.Chen JS, You JF. Current status of surgical treatment for hemorrhoids – systematic review and meta-analysis. Chang Gung Med J, 2010, 33: 488-500.Chen JS, You JF. Current status of surgical treatment for hemorrhoids – systematic review and meta-analysis. Chang Gung Med J, 2010, 33: 488-500.Ommer A, Hinrichs J, Mollenberg H, Marla B, Walz M. K. Longterm results after stapled hemorrhoidopexy: a prospective study with a 6 year follow-up. Dis Colon Rectum, 2011, 54: 601618.Ommer A, Hinrichs J, Mollenberg H, Marla B, Walz M. K. Longterm results after stapled hemorrhoidopexy: a prospective study with a 6 year follow-up. Dis Colon Rectum, 2011, 54: 601618.Shao WJ, Li GC, Zhang ZH. Systematic review and meta analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional Haemorrhoidectomy. Br J Surg, 2008, 95: 147-160.Shao WJ, Li GC, Zhang ZH. Systematic review and meta analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional Haemorrhoidectomy. Br J Surg, 2008, 95: 147-160.Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol, 2014, 18: 291-298.Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol, 2014, 18: 291-298.Jacobs D. Hemorrhoids. N Engl J M, 2014, 371: 944-951.Jacobs D. Hemorrhoids. N Engl J M, 2014, 371: 944-951.Chen JS, You JF. Current status of surgical treatment for hemorrhoids – systematic review and meta-analysis. Chang Gung Med J, 2010, 33: 488-500.Chen JS, You JF. Current status of surgical treatment for hemorrhoids – systematic review and meta-analysis. Chang Gung Med J, 2010, 33: 488-500.Khanna R, Khanna S, Bhadani S, Singh S., Khanna A.K. Comparison of ligasure hemorrhoidectomy with conventional Ferguson’s hemorrhoidectomy. Indian J Surg, 2010, 72: 294297.Khanna R, Khanna S, Bhadani S, Singh S., Khanna A.K. Comparison of ligasure hemorrhoidectomy with conventional Ferguson’s hemorrhoidectomy. Indian J Surg, 2010, 72: 294297.Ommer A, Hinrichs J, Mollenberg H, Marla B, Walz MK. Longterm results after stapled hemorrhoidopexy: a prospective study with a 6-year follow-up. Dis Colon Rectum, 2011, 54: 601618.Ommer A, Hinrichs J, Mollenberg H, Marla B, Walz MK. Longterm results after stapled hemorrhoidopexy: a prospective study with a 6-year follow-up. Dis Colon Rectum, 2011, 54: 601618.Bulus H, Tas A, Coskun A, Kucukazman M. Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Ferguson’s with electrocautery. Asian Journal of Surgery, 2014, 7: 20-23.Bulus H, Tas A, Coskun A, Kucukazman M. Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Ferguson’s with electrocautery. Asian Journal of Surgery, 2014, 7: 20-23.Титов А.Ю., Абрицова М.В. Допплеро-контролируемая дезартеризация внутренних геморроидальных узлов с мукопексией и геморроидэктомия (сравнительное рандомизированное проспективное исследование). Колопроктология, 2015, 1(51): 47-48.Titov AYu, Abritsova MV. Doppler-guided transanal haemorrhoid dearterialization with mucopexy and hemorrhoidectomy (comparative randomized prospective study). Koloproktologia, 2015, 1 (51): 47-48.Altomare DF, Giuratrabocchetta S. Conservative and surgical treatment of haemorrhoids. Na. Rev Gastroenterol Hepatol, 2013, 10: 513-521.Altomare DF, Giuratrabocchetta S. Conservative and surgical treatment of haemorrhoids. Na. Rev Gastroenterol Hepatol, 2013, 10: 513-521.Костарев И.В. Склерозирующее лечение геморроя в сочетании с ультразвуковой кавитацией. Автореф. дисс. ... канд. мед. наук. М., 2008: 22.Kostarev IV. Sclerosing treatment of hemorrhoids in combination with ultrasonic cavitation. Extended abstract of Cand. of Sci. (Med.) Dissertation. M., 2008: 22.Sanchez С, Chinn BT. Hemorrhoids. Clin Colon Recta Surg, 2011, 24: 5-13.Sanchez С, Chinn BT. Hemorrhoids. Clin Colon Recta Surg, 2011, 24: 5-13.Nakeeb AME, Fikry AA, Omar WH et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol, 2008, 14(42): 6525-6530.Nakeeb AME, Fikry AA, Omar WH et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol, 2008, 14(42): 6525-6530.Wolthuis AM, Penninckx F, Cornille JB, Fieuws S, D’Hoore A. Recurrent symptoms after stapled haemorrhoidopexy and the impact on patient satisfaction after a minimum of 2 years follow-up. Acta Chir Belg, 2012, 112(6): 419-422.Wolthuis AM, Penninckx F, Cornille JB, Fieuws S, D’Hoore A. Recurrent symptoms after stapled haemorrhoidopexy and the impact on patient satisfaction after a minimum of 2 years follow-up. Acta Chir Belg, 2012, 112(6): 419-422.Rivadeneira DE, Steele SR, Ternent C, Chalasani S. Practice parameters for the management of hemorrhoids (Revised 2010). The standards practice task force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum, 2011, 54(9): 1059-1064.Rivadeneira DE, Steele SR, Ternent C, Chalasani S. Practice parameters for the management of hemorrhoids (Revised 2010). The standards practice task force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum, 2011, 54(9): 1059-1064.Schuurman JP, Go PMNYH. Anal duplex fails to show changes in vascular anatomy after the haemorrhoidal artery ligation procedure. Colorectal Disease, 2012, 14: e330-e334.Schuurman JP, Go PMNYH. Anal duplex fails to show changes in vascular anatomy after the haemorrhoidal artery ligation procedure. Colorectal Disease, 2012, 14: e330-e334.Абрицова М.В. Допплеро-контролируемая дезартеризация внутренних геморроидальных узлов с мукопексией при 3-4 стадии геморроя. Автореф. дис. ... канд. мед. наук. М., 2013: 24.Abritsova MV. Doppler-guided transanal haemorrhoid dearterialization with mucopexy in patients with stages 3 to 4 hemorrhoids. Extended abstract of Cand. of Sci. (Med.) Dissertation. M., 2013: 24.Титов А.Ю., Абрицова М.В., Орлова Л.П., Фоменко О.Ю., Трубачева Ю.Л., Мтвралашвили Д.А. Сравнительная эффективность допплероконтролируемой дезартеризации с мукопексией и геморроидэктомии. Российский журнал гастроэнтерологии, гепатологии, колопроктологии, 2016, 2(26): 58-63.Titov AYu, Abritsova MV, Orlova LP, Fomenko OYu, Trubacheva YuL, Mtvralashvili DA. Comparative effectiveness of doppler-guided dearterialization with mucopexy and hemorrhoidectomy. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii, 2016, 2 (26): 58-63.Алексеев В.В. Ступенчатая терапия НПВП острого болевого синдрома в пояснично-кресцовой области. Эффективная фармакотерапия в неврологии и психиатрии, 2010, 4: 22–28.Alekseev VV. NSAID step therapy for acute pain in the lumbosacral region. Effektivnaya Farmakoterapiya v Nevrologii i Psikhiatrii, 2010, 4: 22–28.Шостак Н.А., Правдюк Н.Г., Егорова В.А. Боль в спине у пожилых – подходы к диагностике и лечению. Клиницист, 2011, 3: 72-77.Shostak NA, Pravdyuk NG, Egorova VA. Back pain in the elderly approaches to diagnosis and treatment. Klinitsist, 2011, 3: 72-77.Jelinek GA. Ketorolac versus morphine for severe pain. Ketorolac is more effective, cheaper, and has fewer side effects. Br Med J, 2000, 321: 1236-1237.Jelinek GA. Ketorolac versus morphine for severe pain. Ketorolac is more effective, cheaper, and has fewer side effects. Br Med J, 2000, 321: 1236-1237.Bursics A, Morvay K, Kupcsulik P, Flautner L. Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis, 2004, 19: 176-180.Bursics A, Morvay K, Kupcsulik P, Flautner L. Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis, 2004, 19: 176-180.Hussein AM. Ligation-Anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum, 2001, 44: 1887-1890.Hussein AM. Ligation-Anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum, 2001, 44: 1887-1890.Roka S, Gold D, Walega P. et al. DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study. Eur Surg, 2013, 45: 26-30.Roka S, Gold D, Walega P. et al. DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study. Eur Surg, 2013, 45: 26-30.

The authors declare that there are no conflicts of interest present.