Poen A C, Felt-Bersma R J, Cuesta M A, Devillé W, Meuwissen S G
Department of Surgery, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Eur J Gastroenterol Hepatol. 2000 May;12(5):535-9. doi: 10.1097/00042737-200012050-00010.
Despite the presence of numerous non-surgical therapies for the treatment of haemorrhoids, none of these therapies has clearly been proven to be superior. The effectiveness and patient tolerance of rubber band ligation (RBL) and infra-red coagulation (IRC) in the treatment of haemorrhoids was assessed.
Prospective randomized trial.
Academic hospital (tertiary care).
A total of 133 consecutive patients (73 males, 60 females, mean age 48 years (range 19-82)) with internal haemorrhoids, and without concomitant anorectal disease, were randomized to rubber band ligation (RBL, n = 65) or infra-red coagulation (IRC, n = 68).
Rubber band ligation or infra-red coagulation was performed in one or more sessions with four-week intervals until symptoms had resolved. Treatment outcome and side-effects were assessed after each treatment session and one month after the last treatment by proctological examination and a questionnaire, including a pain score (visual analogue scale from 0 to 10). Recurrence of complaints was assessed by telephone questionnaire [mean follow-up of 19.2 months (SD 7.8)].
Treatment outcome was assessed in 124 patients (60 RBL, 64 IRC). The mean number of treatment sessions was 1.6 (SD 0.9) for both therapies. For RBL, 58 patients (97%), and for IRC, 59 patients (92%) were symptom-free or had satisfactorily improved. Only third-degree haemorrhoids seemed to respond better to RBL (five of five patients symptom-free) than to IRC (two of four patients symptom-free). Pain following treatment was more common and more severe after RBL (VAS 5.5 +/- 3.7) than after IRC (VAS 3.3 +/- 3.3, P= 0.018). The telephone questionnaire was answered by 105 patients. Nine of 50 patients (18%) treated with RBL and 11 of 55 patients (20%, P= 0.81) treated with IRC had experienced symptomatic relapse to pre-treatment levels.
Infra-red coagulation and rubber band ligation are equally effective in the treatment of haemorrhoids. The rate and severity of pain is higher after rubber band ligation. Infra-red coagulation should be the first-line treatment for haemorrhoids.
尽管存在多种用于治疗痔疮的非手术疗法，但尚无一种疗法被明确证明更具优势。本研究评估了橡皮圈套扎术（RBL）和红外线凝固术（IRC）治疗痔疮的有效性及患者耐受性。
前瞻性随机试验。
教学医院（三级医疗中心）。
共有133例连续的内痔患者（男性73例，女性60例，平均年龄48岁（范围19 - 82岁）），且无伴发的肛肠疾病，被随机分为橡皮圈套扎术组（RBL，n = 65）或红外线凝固术组（IRC，n = 68）。
橡皮圈套扎术或红外线凝固术分一次或多次进行，间隔四周，直至症状缓解。每次治疗后及最后一次治疗后一个月，通过直肠检查和问卷调查评估治疗效果及副作用，问卷包括疼痛评分（视觉模拟量表，0至10分）。通过电话问卷调查评估症状复发情况[平均随访19.2个月（标准差7.8）]。
对124例患者（60例RBL，64例IRC）评估了治疗效果。两种疗法的平均治疗次数均为1.6次（标准差0.9）。对于RBL，58例患者（97%）症状消失或有满意改善；对于IRC，59例患者（92%）症状消失或有满意改善。仅三度痔疮似乎对RBL的反应（5例患者中有5例症状消失）优于IRC（4例患者中有2例症状消失）。治疗后疼痛在RBL组（视觉模拟评分5.5±3.7）比IRC组（视觉模拟评分3.3±3.3，P = 0.018）更常见且更严重。105例患者回答了电话问卷。接受RBL治疗的50例患者中有9例（18%），接受IRC治疗的55例患者中有11例（20%，P = 0.81）症状复发至治疗前水平。
红外线凝固术和橡皮圈套扎术在治疗痔疮方面同样有效。橡皮圈套扎术后疼痛的发生率和严重程度更高。红外线凝固术应作为痔疮的一线治疗方法。
