Use of Hemorrhoid Energy Treatment Combined with Vessel Sealer for Grade III and IV Hemorrhoidectomy

Purpose. We evaluated whether the use of hemorrhoid energy treatment (HET) combined with the Erbe energy device for hemorrhoidectomy was associated with reduced pain and lower bleeding rates. Methods. This single-center retrospective study included 59 patients with grade III or IV hemorrhoids. All patients underwent hemorrhoidectomy with the Erbe device or with the Erbe device plus hemorrhoid energy treatment (HET). Patients' clinical characteristics and prognosis were analyzed. Results. In patients using the Erbe device, the bleeding rate was 24% (n = 6/25), which was higher than that of patients using the Erbe device combined with HET (11.8%; n = 4/34), but without statistical significance (p = 0.93). In addition, there was no significant difference in postoperative side effects, including urine retention (p = 1.0), anal stricture (p = 1), or number of days during which softeners were used (p = 0.59). Only one case of urine retention occurred in the Erbe combined with HET group, which improved after one intermittent catheterization procedure in hospital care. One patient in the Erbe device group experienced anal stricture and was readmitted to our hospital 1 month post surgery. High postoperative pain (visual analog scale > 3 points) occurred in 32.4% of patients in the Erbe combined with HET group as compared with 20% of patients using the Erbe device alone (p = 0.44). Conclusions. Among patients with grade III or IV hemorrhoids, HET combined with the Erbe system hemorrhoidectomy may provide a new technique in hemorrhoidectomy and decrease the bleeding rate after operation.

關鍵字

Hemorrhoidectomy ； HET ； Erbe ； Postoperative bleeding

並列摘要

目的：運用雙極結紮法與組織凝結儀系統針對第三級與第四級痔瘡治療，降低該群病人術後疼痛與術後出血比率。方法：回朔性分析單一醫學中心自2021年3月至2021年11月共59名被診斷第三級或是第四級痔瘡，其中25位病患接受組織凝合儀治療，另外34名接受新型雙集結紮法合併組織凝合儀，此研究比較兩組織結果與術後反應均納入分析。結果：針對指使用Erbe組痔瘡切除手術和使用HET合併Erbe組痔瘡切除手術中，單純使用Erbe組出血機率為24%（n=6/25），而使用HET合併Erbe組痔瘡切除手術其出血機率為11.8%（4/34），病人使用HET合併Erbe組痔瘡切除手術出血機率較低，然而統計尚未達顯著差異（p=0.93）此外比較兩組其術後尿滯留，肛門狹窄與使用軟便劑天數，均未達明顯統計上差異（p=1），（p=0.59）一位病人產生術後尿滯留之併發症，發現在使用HET合併Erbe痔瘡切除手術，在導尿後改善出院，而有一位病人接受Erbe痔瘡切除手術，產生肛門狹窄之併發症，有重新住院接受括約肌放鬆手術在痔瘡手術後約一個月。此外針對術後肛門疼痛調查中，疼痛大於3分在單純使用Erbe組中約為20%（n=5/25）對比Erbe合併HET使用組為34%（n=11/34），在同時使用HET合併Erbe組中有較高痛機率，但統計尚未發覺顯著差異性（p=0.44）。結論：雙極結紮法合併組織凝結儀之痔瘡切除手術，可能提供一個新的選擇針對第三第四級痔瘡切除手術，並且降低其術後出血之風險。

並列關鍵字

痔瘡切除手術；術後出血；雙極結紮法；組織凝結儀

參考文獻

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