A New Method For Hemorrhoid Surgery: Intrahemorrhoidal Diode Laser, Does It Work?
A New Method For Hemorrhoid Surgery: Intrahemorrhoidal Diode Laser, Does It Work?
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DOI：
10.1089/pho.2008.2368
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发表时间：
2009-10-01
影响因子：
--
通讯作者：
Fukuda, Thiago
中科院分区：
文献类型：
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作者：
Plapler, Helio;Hage, Raduan;Fukuda, Thiago
目的：本研究旨在描述半导体激光痔内应用的临床结果。背景资料：痔疮是一种常见的疼痛来源，没有一种手术技术可以达到无痛的效果。实验研究中描述的静脉曲张血管内激光治疗是一种可用于治疗痔疮的方法，但文献中描述的临床试验很少。材料与方法：对15例Ⅱ度、Ⅲ度痔患者行痔内激光治疗。在确定绒毛后，将纤维引入每个绒毛中，并用激光能量（810 nm，5 W，频率5 Hz，能量密度19 J/cm（2），总能量4-10 J）照射。结果如下：术后7、14、21和28 d的临床检查显示9例患者（60.4%）完全愈合，5例患者（33%）部分缓解。1例患者（6.6%）治疗失败。通过视觉模拟量表（0-10）测量的整个研究期间的平均疼痛强度为0.84 +/- 1.13（平均值+/- SD）。主要并发症为烧伤病变（n = 4）和残留皱襞（皮赘）（n = 5）。10名对照患者接受了开放式“冷刀”痔切除术。他们的疼痛强度为1.78 +/- 0.68（平均值+/- SD）。两组之间存在显著的统计学差异（p = 0.018）。结论：与开放式痔切除术相比，将半导体激光能量输送到小到中等痔桩中引起的疼痛很小，并在短时间内导致部分到完全消退。必须进行一些调整，以防止灼伤和残留皱襞。虽然这不是一个很好的方法，大桩，这项技术开辟了新的可能性，痔疮疾病的手术治疗。
Objective: This study aimed to describe the clinical results of intrahemorrhoidal application of a diode laser. Background Data: Hemorrhoids are a common source of pain, and no surgical technique achieves a painless outcome. Endovascular laser therapy for varicose veins as described in an experimental study is a method that could be used in the treatment of hemorrhoids, but there are few clinical trials described in the literature. Materials and Methods: Fifteen patients with second and third degree hemorrhoids underwent intrahemorrhoidal laser therapy. After the piles were identified, a fiber was introduced into each and it was irradiated with laser energy (810 nm, 5W, frequency of 5 Hz, energy density of 19 J/cm(2), total energy of 4-10 J). Results: The piles were immediately partially reduced, and clinical examination 7, 14, 21, and 28 d after surgery showed complete healing in nine patients (60.4%) and partial resolution in five patients (33%). In one patient (6.6%) the treatment failed. Mean pain intensity throughout the study period, measured by a visual analog scale (0-10), was 0.84 +/- 1.13 (mean +/- SD). Major complications were burn lesions (n = 4) and residual plicoma (skin tag) (n = 5). Ten control patients underwent an open "cold scalpel'' hemorrhoidectomy. Their pain intensity was 1.78 +/- 0.68 (mean +/- SD). There was a significant statistical difference (p = 0.018) between groups. Conclusion: The diode laser energy delivered into small to median hemorrhoidal piles caused little pain and led to a partial to complete resolution within a short time compared to open hemorrhoidectomy. Some adjustments must be made to prevent burning lesions and residual plicoma. Although it is not a good method for big piles, this technique opens new possibilities for surgical treatment of hemorrhoidal disease.