RESUMO
AIM: To compare two methods of hemorrhoid treatment. MATERIAL AND METHODS: This prospective study included 240 patients with hemorrhoids stage III-IVA. Stages III and IVA were diagnosed in 156 (65%) and 84 (35%) patients respectively. Randomization was performed using envelopes method in one to one distribution. In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM), in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE). RESULTS: Duration of surgery was 17.9±6.1 and 34.5±10.1 minutes in DDM and HE groups respectively (p<0.01). Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01). Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01). Disability period was 14.4±5.2 and 30.3±5.4 days in both groups respectively (p<0.01). Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively. Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days. CONCLUSION: DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE. DDM reduces postoperative pain severity, hospital stay and disability period.
Assuntos
Hemorroidectomia , Hemorroidas , Mucosa Intestinal , Dor Pós-Operatória , Proctoscópios , Adulto , Pesquisa Comparativa da Efetividade , Desenho de Equipamento , Feminino , Hemorroidectomia/efeitos adversos , Hemorroidectomia/instrumentação , Hemorroidectomia/métodos , Hemorroidas/patologia , Hemorroidas/fisiopatologia , Hemorroidas/cirurgia , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
The results of examinations and treatment of 338 patients operated by reason of perforated gastric and duodenal ulcer (PGDU). It was established, that parenteral and oral nutrition in PGDU patients after traditional surgical operation did not improve patients' trophic state. Performance of early enteral nutrition with Pevzner's diet and nutritive maintenance during all postoperative period in patients, operated by low-invasive methods, has favorable influence on patients' trophic state.
