TRANSANAL HAEMORRHOIDAL DEARTERIALIZATION WITH MUCOPEXY (THD-M) FOR TREATMENT OF HEMORRHOIDS: IS IT APPLICABLE IN ALL GRADES? BRAZILIAN MULTICENTER STUDY

ABSTRACT Background: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option for treating patients with haemorrhoidal disease. However, there is still controversy with regard to its efficacy for more advanced grades. Aim: To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades. Method: Seven hundred and five consecutive patients with Goligher’s grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres. Six well-trained and experienced surgeons operated on the patients. Average follow-up was 21 months (12-48). Results: Intraoperative complications were observed in 1.1% of cases, including four cases of haematoma, two of laceration of the mucosa, and two of bleeding. All of these were controlled by means of haemostatic suturing. In relation to postoperative complications, the most common of these were as follows: transitory tenesmus (21.4%); pain (7.2%); mucosal or haemorrhoidal prolapse (6.4%); residual skin tag (5.6%); faecal impaction (3.2%); haemorrhoidal thrombosis (2.8%); bleeding (2.1%); anal fissure (0.7%); and anal abscess (0.3%). Most of the complications were treated conservatively, and only 7.5% (53/705) required some type of surgical approach. There was no mortality or any severe complications. The recurrence of prolapse and bleeding was greater in patients with grade IV haemorrhoidal disease than in those with grade III and II (26.54% and 7.96% vs. 2.31% and 0.92% vs. 2.5% and 1.25%), respectively. Conclusion: The THD-M method is safe and effective for haemorrhoidal disease grades II and III with low rates of surgical complications. However, for grade IV hemorrhoids, it is associated with higher recurrence of prolapse and bleeding. So, THD-M method should not be considered as an effective option for the treatment of grade IV hemorrhoids.

摘要 研究背景：经肛痔动脉结扎联合黏膜固定术（Transanal haemorrhoidal dearterialization with mucopexy，THD-M）是治疗痔病的有效方案，但针对重度痔病的临床疗效仍存在争议。研究目的：评估THD-M术式治疗痔病的临床有效性，并对比不同分度痔病的即刻与远期治疗效果。研究方法：本研究纳入705例连续性症状性Goligher Ⅱ、Ⅲ、Ⅳ度痔病患者，于5家合作中心接受THD-M术式治疗，由6名经过系统培训且经验丰富的外科医师完成手术，平均随访时长为21个月（12~48个月）。研究结果：术中并发症发生率为1.1%，具体包括4例血肿、2例黏膜撕裂及2例出血，所有并发症均通过止血缝合得到有效控制。术后常见并发症依次为：暂时性里急后重（21.4%）、疼痛（7.2%）、黏膜或痔脱出（6.4%）、残余皮赘（5.6%）、粪便嵌塞（3.2%）、痔血栓形成（2.8%）、出血（2.1%）、肛裂（0.7%）及肛周脓肿（0.3%）；绝大多数并发症可通过保守治疗控制，仅7.5%（53/705）的患者需接受手术干预。本研究无死亡病例及严重并发症发生。Ⅳ度痔病患者的脱出与出血复发率分别为26.54%、7.96%，显著高于Ⅲ度患者的2.31%、0.92%及Ⅱ度患者的2.5%、1.25%。研究结论：THD-M术式用于治疗Ⅱ、Ⅲ度痔病安全有效，手术并发症发生率较低；但针对Ⅳ度痔病患者，该术式的脱出与出血复发率较高，因此不应将THD-M术式作为Ⅳ度痔病的推荐治疗方案。