Severinov S.I., Roganov G.G., Kushnir K.G.

Crimea state medical university named after S. I. Georgievsky

“The influence of different surgical Doppler's approaches to gemorroektomia”

Summary

The hemorrhoids - a widespread disease in the adult population, its frequency is 40% of total proctological diseases. In clinical practice, widely used minimally invasive treatments for hemorrhoids - latex internal hemorrhoid ligation, infrared photocoagulation, sclerotherapy.

However, studies have shown that they can be used only in the early stages of the disease. The greatest spread the word got gemorroektomiya by type of operation. While after gemorroektomii in the literature in 23-34% patients have severe pain syndrome that requires repeated use of narcotic analgesics, at 15-24% - voiding, leading to the need to stimulate long-term medical and catheterization.

Despite the widespread use minimally invasive techniques to treat hemorrhoids, it should be noted that all these methods are only aimed at relief of the symptoms of hemorrhoids, without affecting the main pathogenetic factors of hemorrhoidal disease. Typically, this applies to patients with the most advanced disease, loss of internal hemorrhoids with rectal mucosa, the presence of external sites marked with a penchant for frequent perianal thrombosis.Studies of foreign and domestic Coloproctologists in recent years have shown that the radical gemorroektomiya no more than 30% of patients hemorrhoidal disease.

We believe that the best way to treat hemorrhoids in the first place should be effective with the main pathogenetic factors to be easy to use, well tolerated, not accompanied by severe pain, do not require special anesthesia and hospitalization. Major pathogenetic factors of hemorrhoids are amplified flow of arterial blood to piles nodes, as well as degeneration and weakening of ligaments. This causes enlargement of the cavernous tissue, bleeding and prolapsed hemorrhoids from the anus. In anatomical studies have shown that the main source of arterial blood to hemorrhoidal nodes are the distal branches of the unpaired left common iliac artery. In this regard, we have attempted to make a comparative evaluation of different surgical approaches to the treatment of chronic hemorrhoids using Doppler ultrasound.

Materials and methods
The material of our study were the rates Doppler ultrasound of patients who underwent surgical treatment of chronic hemorrhoids. To conduct the study was examined 41 patients (11 women and 30 men) aged 30 to 53 years. Patients were divided into two groups: the first group - the control group (traditional method of surgery) included 15 patients, the second group - the main (we have developed a modified method of surgical treatment of chronic hemorrhoids) included 26 patients. Doppler ultrasound study was performed before surgery and at 14 and 30 days after surgery.

Endorectal color duplex scanning hemorrhoids were performed on the ultrasound machine «Siemens Sonoline G 60S» universal sensor with a frequency range from 6 to 10 MHz. Re-control study was carried out 2-4 weeks after surgery. In the preoperative period, the study hemorrhoids ultrasonographic assessment of their structure and size, and also recorded the blood flow in the legs projection vascular hemorrhoids. Postoperatively, the size, structure and scarring presence or absence of blood flow in the Khone previously executed operations.

Ultrasound probe in the study at a depth of field which allows to examine the necessary and expected of a surgical exposure. The depth of the anal canal to the working surface of not more than 5 cm endorectal color duplex scanning was conducted with the patient lying on his left side with those given to the stomach down. The resulting digital data processed by variation statistics and calculation of t-test, considered reliable indicators at p <0.05.

Results of the study
In the analysis of Doppler ultrasound in patients with chronic hemorrhoids were statistically significant, in the control and in the main group of observations, increasing blood flow, and the venous blood flow decreased. Middle piles artery caliber increased. Two weeks after surgery in patients who used traditional methods where there is stabilization of the studied parameters, so the rate of blood flow was 14.8±0.7 cm / sec, which was 24.3% (p <0.05) lower control, and the rate of venous blood flow increased and was 13.5 and 0.5 cm / sec, which was at 18,2% (p <0,05) lower than control when it, with an average caliber of piles arteries decreased and amounted to 1.46 ± 0.55 mm, up 58.6% (p <0.001) higher benchmarks.

In the analysis of the studied parameters for the two week period of observation after surgery in patients of the main group of the modified method of surgical treatment of chronic hemorrhoids for the most part the whole range of the studied parameters is approaching that of the acquisition of control with respect to benchmarks invalid character (p1 <0.05).

By 30 days after surgery in patients with conventional surgical approaches (control group), and when using the modified method (study group), all studied parameters were normalized, the most striking and significant - in the main group.

Conclusions:
Held Doppler ultrasound in patients with chronic hemorrhoids showed that during chronic hemorrhoids is accompanied by an increase in the velocity of blood flow, decrease in the rate of venous blood flow and a significant increase in the average caliber of hemorrhoidal artery. The study of traditional approaches leads to an imbalance in the rate of blood flow (artery-vein), which continues up to 2 weeks after surgery. Our proposed modified method gemorroektomii accelerates the repair processes.