Roganov G.G., Kushnir K.G., Nepreluk O.A

Crimea state medical university named after S. I. Georgievsky, Simferopol.

Monitoring of ultrasonic dopplerography indicators in patients with chronic hemorrhoids before and after surgical treatment with various surgical approaches.

Hemorrhoids is a widespread disease in the adult population, its frequency is 40% of total proctologic diseases. According to the literature, every third patient with hemorrhoids requires surgical treatment.

In our country the most widespread type of operation is hemorrhoidectomy.

Average rehabilitation term after hemorrhoidectomy is at least 4 weeks, and the number of postoperative complications is large.

Recent years studies have shown that only 30% of patients with hemorrhoidal disease needs radical hemorrhoidectomy. Typically, this applies to patients with the most severe stages of the disease.

Although the that hemorrhoidectomy is considered by most surgeons as a radical way to treat hemorrhoids within 2-3 years after the intervention disease recurrence is seen in 1-3% of patients, after 10-12 years - in 8.3% of patients.

In this regard, in clinical practice, have been widely used non-invasive ways to treat hemorrhoids - latex internal hemorrhoid ligation, infrared photocoagulation, sclerotherapy. However, the observation of treatment results showed that non-invasive methods of hemorrhoid treatment should be used only in patients in the early stages of the disease. For example, during long-term observation recurrence of disease occurs in 15% of patients who have had latex ligation of internal hemorrhoids.

Despite the wide spread of minimally invasive treatments of hemorrhoids, it should be noted that all these methods are directed only to relief the symptoms of hemorrhoids without affecting the main pathogenetic factors of the disease.

In our opinion, the best way to treat hemorrhoids in the first place, should have an effective impact on major contributing factors to be easy to use, well tolerated by patients, not accompanied by severe pain, do not require special anesthesia and hospitalization

According to modern theories of hemorrhoids pathogenesis, the main causal factors are amplified inflow of arterial blood to hemorrhoidal nodes, as well as degeneration and weakening of ligaments. This leads to hypertrophy of the cavernous tissue, bleeding and prolapsing hemorrhoids from the anus.

In this context, we attempted to make a comparative evaluation of different surgical approaches to the treatment of chronic hemorrhoids with using Doppler ultrasonography.

Materials and methods. The material of this study were indicators of Doppler ultrasonography of patients who underwent surgical treatment of chronic hemorrhoids. 41 patients were examined for the study. Patients were divided into 2 groups: control (the traditional method of surgical treatment), and the main (we have developed a modified method of chronic hemorrhoids surgical treatment of chronic hemorrhoids) Endorectal color duplex scanning of hemorrhoids was performed on the ultrasound machine «Siemens Sonoline G 60S» using universal sensor with a frequency range from 6 to 10 MHz. Initial ultrasound study was performed before surgery. Control study was performed 2-4 weeks after surgery.

In the preoperative period hemorrhoids were examined with ultrasonographic evaluation of their structure and size. In the postoperative period we examined the size and structure of scars, presence or absence of blood flow in previously operated area.

The results of the study. In the analysis of Doppler ultrasonography in patients with chronic hemorrhoids were statistically significant, in both the control and observation groups, increase in arterial blood flow to 38,6-35,2% (p <0.01), which was 16,5 ± 0.9 cm / sec 16,1 ± 0,7 cm / sec, respectively, and venous blood flow decreased by 23.0 and 20.0%, respectively (p <0.05) and was 12,7 ± 0,7 and 18,2 ± 0,9 cm / sec respectively. Average caliber of haemorrhoidal artery increased by 70,6-68,4%, respectively (p <0.001) and was 1,57 ± 0,68 mm in the control group and 1,55 ± 0,55 mm in the primary group. Two weeks after surgery in patients who used traditional methods there where stabilization of the studied parameters-arterial blood flow rate was 14,8 ± 0,7 cm / sec, which was 24.3% (p <0.05) lower than controland the speed of venous blood flow increased and amounted to 13,5 ± 0,5 cm / sec, which was 18.2% (p <0.05) lower than control. Average gauge of hemorrhoidal arteries decreased and amounted to 1,46 ± 0,55 mm, which was 58.6% (p <0.001) higher than control. In the analysis of the studied parameters to the two-week period of observation after surgery in the treatment group for the most part the whole range of investigated parameters approach the rate of control gained with relative to the control parameters invalid character (pi> 0,05). On the 30th day after the operation, in both groups, all the studied parameters return to normal. Most strongly - in the main group.

Thus, ultrasound examination of patients with chronic hemorrhoids shown that the disease is accompanied by increased arterial blood flow rate, speed reduction of the venous blood flow and aorrhoid significant increase in the average caliber haemorrhoidal artery. Research has shown that the traditional approach leads to an imbalance in the rate of blood flow (artery - vein), which continues up to 2 weeks after surgery. Our modified method of treatment accelerates the repair processes.