激光粘膜下破坏治疗痔疮

Q3 Medicine
S. A. Frolov, D. V. Vyshegorodtsev, A. M. Kuzminov, Vyaheslav Yuliya L. Trubacheva, Yu. Korolik, I. S. Bogormistrov, Ivan A. Mukhin, Arseniy N. Ryndin, Akbermet A. Anarbaeva, С.А. Фролов, Д.В. Вышегородцев, А. М. Кузьминов, Ю.Л. Трубачева, В.Ю. Королик, И.С. Богормистров, И.А. Мухин, А.Н. Рындин, А.А. Анарбаева
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The efficiency of the destruction of internal hemorrhoids and the frequency of relapses of the disease were evaluated. The effectiveness of the proposed method was evaluated using anoscopy, measurement of the size of internal hemorrhoidal nodes, transrectal ultrasound with dopplerography. The analysis of the intensity of the pain syndrome, the consumption of nonsteroidal anti-inflammatory drugs and the assessment of the quality of life on the SF-36 scale was carried out. Sphincterometry was performed in all patients to determine the possible effect of laser radiation on the rectal locking apparatus. To assess the possible causes of complications, a single-factor analysis of the amount of energy transferred to each hemorrhoidal node and the total amount of energy spent on the operation was conducted.Results. In all patients, by day 7 after surgery, the pain syndrome in 43 patients (75.4 %) corresponded to 0 points according to VAS. 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引用次数: 0

摘要

目的:提高二、三期痔疮患者的治疗效果。材料和方法。前瞻性研究包括60例2期和3期痔疮患者。所有患者都接受了波长为1940 nm的二极管泵浦光纤激光器的内痔破坏。该技术是基于激光能量对内痔结海绵状组织和直肠上动脉末端分支的影响。评估内痔的破坏效率和疾病复发的频率。通过肛门镜检查、内痔淋巴结大小测量、经直肠超声多普勒成像评估该方法的有效性。分析两组患者疼痛综合征的强度、非甾体类抗炎药的使用情况及SF-36生活质量评价。所有患者均行括约肌测量术,以确定激光照射对直肠锁定装置可能产生的影响。为了评估并发症的可能原因,我们对每个痔结的能量转移量和手术中消耗的总能量进行了单因素分析。在所有患者中,术后第7天,有43例(75.4%)患者的疼痛综合征根据VAS评分达到0分。术中出血3例(5%)。术后早期5例(8.3%)出现7例并发症,其中外痔结血栓形成5例,急性尿潴留2例。单因素分析显示,并发症的发生与整个手术过程中输送到各个痔结的能量及其总量有关。在长达6个月的时间里,在任何情况下都没有疾病复发的迹象(痔疮脱垂和出血)。术前发现的痔疮,术后1个月未见,术后6个月未见。经过长达6个月的经直肠超声波谱多普勒检查,可以诊断出与术前相比,直肠上动脉末端分支的血流持续减少。当进行括约肌测量时,肛门括约肌功能参数与术前参数相比没有变化。采用波长为1940 nm的二极管泵浦光纤激光器,可以在不损伤肛管粘膜的情况下经皮影响内痔结。术后肛管无创面,疼痛综合征减轻,术后第7天无痔疮临床表现。激光破坏内痔的方法可以在门诊条件下使用,可以提高患者术后早期的生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ilaser Submucous Destruction in the Treatment of Hemorrhoids
Aim: to improve the results of treatment in patients with hemorrhoids of the 2nd and 3rd stages.Materials and methods. The prospective study included 60 patients with hemorrhoids of the 2nd and 3rd stages. All patients underwent destruction of internal hemorrhoids with a fiber laser with a diode pump with a wavelength of 1940 nm. The technique is based on the effect of laser energy on the cavernous tissue of the internal hemorrhoidal node and on the terminal branches of the upper rectal artery. The efficiency of the destruction of internal hemorrhoids and the frequency of relapses of the disease were evaluated. The effectiveness of the proposed method was evaluated using anoscopy, measurement of the size of internal hemorrhoidal nodes, transrectal ultrasound with dopplerography. The analysis of the intensity of the pain syndrome, the consumption of nonsteroidal anti-inflammatory drugs and the assessment of the quality of life on the SF-36 scale was carried out. Sphincterometry was performed in all patients to determine the possible effect of laser radiation on the rectal locking apparatus. To assess the possible causes of complications, a single-factor analysis of the amount of energy transferred to each hemorrhoidal node and the total amount of energy spent on the operation was conducted.Results. In all patients, by day 7 after surgery, the pain syndrome in 43 patients (75.4 %) corresponded to 0 points according to VAS. In 3 patients (5 %) intraoperative hemorrhage developed. In the early postoperative period, 5 patients (8.3 %) had 7 complications: 5 cases of thrombosis of the external hemorrhoidal node and 2 — of acute urinary retention. The conducted single-factor analysis showed the dependence of the development of complications on the energy transferred to each hemorrhoidal node and its total amount for the entire operation. In terms of up to 6 months, there were no signs of a return of the disease in any case (hemorrhoidal prolapse and blood discharge). The detected hemorrhoids before the operation, a month after the operation, were not visualized, which persisted after 6 months. The performed transrectal ultrasound examination with spectral-wave dopplerography for up to 6 months allowed to diagnose a persistent decrease in blood flow along the terminal branches of the upper rectal artery compared with preoperative values. When performed sphincterometry, there was no change in the parameters of the anal sphincter function compared to preoperative parameters.Conclusion. The proposed method applying a fiber laser with a diode pump with a wavelength of 1940 nm makes it possible to affect transdermally the internal hemorrhoidal node without damaging the mucosa of the anal canal. The absence of postoperative wounds in the anal canal leads to a decrease in pain syndrome, and by day 7 there are no clinical manifestations of hemorrhoids. The method of laser destruction of internal hemorrhoids can be used in outpatient conditions and can improve the quality of life of patients in the early postoperative period.
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CiteScore
1.90
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0.00%
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