Hemorrhoidal elastic band ligation with flexible videoendoscopes: a prospective, randomized comparison with the conventional technique that uses rigid proctoscopes
Hemorrhoidal elastic band ligation with flexible videoendoscopes: a prospective, randomized comparison with the conventional technique that uses rigid proctoscopes
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DOI：
10.1016/s0016-5107(04)01551-2
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发表时间：
2004-08-01
影响因子：
7.7
通讯作者：
Stergiou, N
中科院分区：
文献类型：
--
作者：
Wehrmann, T;Riphaus, A;Stergiou, N
背景资料：对于有2 - 3级内痔症状的患者，通过硬性直肠镜进行弹性带结扎是首选的治疗方法。与柔性电子内窥镜相比，刚性直肠镜的可操作性有限，视野较窄，并且不允许进行充分的记录。因此，进行了一项随机试验，比较传统的弹性带结扎与videoendoscopic弹性带ligation.Methods的安全性和有效性：共100例连续患者（平均年龄47 [12]岁）与慢性出血2级或3级内痔被随机弹性带结扎或videoendoscopic弹性带结扎。对于视频内窥镜弹性带结扎，将可重复使用的多带结扎器连接到治疗性上视频内窥镜的末端。在两组中，每节课放置1至3个带。两组每2 - 3周进行一次再治疗，直至出血停止和痔疮根除（至少2级）。此后，对患者进行随访，以评估并发症和疗效。结果：为了达到预期的治疗目的，视频内镜下弹力带结扎组所需的治疗次数明显减少（1.8 [0.8]对2.4 [0.9]; p < 0.01），并且应用的条带总数显著较少（2.8（1.1]对3.7 [1.4]; p < 0.01）。橡皮圈结扎组中25%的患者在结扎后出现疼痛，而视频内窥镜橡皮圈结扎组中有27%的患者出现疼痛。然而，仅7%的弹性带结扎术后和9%的视频内窥镜弹性带结扎（NS）术后需要镇痛药物。结扎后出血，必须在内镜下治疗发生在3.5%的弹性带结扎组和3.2%的视频内窥镜弹性带结扎组（NS）。无需输血。中位随访12个月时，传统橡皮圈结扎组40例（80%）患者未再出血，而视频内镜橡皮圈结扎组（NS）43例（86%）患者未再出血。结论：传统橡皮圈结扎和视频内镜橡皮圈结扎的长期疗效和安全性具有高度可比性。然而，当进行视频内窥镜弹性带结扎时，需要的治疗次数明显减少。
Background: Elastic band ligation by means of a rigid proctoscope is the treatment of choice for patients with symptoms caused by internal hemorrhoids of grade 2 to 3. In contrast to the flexible videoendoscope, the rigid proctoscope has limited maneuverability, has a narrower field of view, and does not allow adequate documentation. Therefore, a randomized trial was conducted to compare the safety and the efficacy of conventional elastic band ligation with videoendoscopic elastic band ligation.Methods: A total of 100 consecutive patients (mean age 47 [12] years) with chronically bleeding grade 2 or 3 internal hemorrhoids were randomized to elastic band ligation or videoendoscopic elastic band ligation. For videoendoscopic elastic band ligation, a reusable multiband ligator was attached to the end of a therapeutic upper videoendoscope. From one to 3 bands were placed per session in both groups. Re-treatment was performed every 2 to 3 weeks in both groups until cessation of bleeding and eradication of the hemorrhoids (at least grade 2) were achieved. Thereafter, the patients were followed to assess complications and efficacy. Recurrent bleeding was considered a treatment failure.Results: To achieve the desired therapeutic aims, a significantly lower number of treatment sessions was required in the videoendoscopic elastic band ligation group (1.8 [0.8] vs. 2.4 [0.9]; p < 0.01) and the total number of bands applied was significantly less (2.8 (1.1] vs. 3.7 [1.4]; p < 0.01). Pain was noted after ligation by 25% of patients in the elastic band ligation group compared with 27% of those who had videoendoscopic elastic band ligation. However, analgesic medications were required in only 7% after elastic band ligation and 9% after videoendoscopic elastic band ligation (NS). Post-ligation bleeding that had to be treated endoscopically occurred in 3.5% of the patients of the elastic band ligation group and 3.2% of those in the videoendoscopic elastic band ligation group (NS). Blood transfusion was not required. At a median follow-up of 12 months, there was no recurrence of bleeding in 40 patients (80%) in the conventional elastic band ligation group vs. 43 (86%) in the videoendoscopic elastic band ligation (NS).Conclusions: The long-term efficacy and safety of conventional elastic band ligation and videoendoscopic elastic band ligation are highly comparable. However, when videoendoscopic elastic band ligation is performed, significantly fewer treatment sessions are required.