Pérez Vicente F, Fernández Frías A, Arroyo Sebastián A, Serrano Paz P, Costa Navarro D, Candela Polo F, Ferrer Riquelme R, Oliver García I, Lacueva Gómez F J, Calpena Rico R
Unidad de Coloproctología. Hospital Universitario de Elche. Alicante, Spain.
Rev Esp Enferm Dig. 2003 Feb;95(2):110-4, 105-9.
to assess the effectiveness of ambulatory rubber band ligation (RBL) in the treatment of symptomatic internal haemorrhoids and to identify factors related to relapse.
prospective study of 232 patients treated with rubber band ligation for symptomatic haemorrhoids (grade I-III or grade IV with severe contraindication for surgery) from November 1996 to November 2000 at the outpatient clinic. Ligation was performed with a Stille AB (Comedic) ligator and suction pump, placing 1-3 bands per session and with up to three sessions per patient. Effectiveness of treatment was defined as the absence of symptoms and was confirmed by anoscopy by checking the residual scar after the cushions' detachment. Categorical variables were compared using the shi-squared test, whereas Student's t-test was used for continuous variables. Logistic regression was employed to identify clinical factors related to relapse.
a total of 331 bands were placed during 235 sessions in the 163 patients who completed follow-up (70%). Mean age was 45.6 years, with males accounting for 64.4%. Most patients (86.5%) had grade II or grade III haemorrhoids. Overall morbidity was 6%. The most frequent complications were rectal tenesmus (11%), slight or mild anal pain (7.4%), dysuria (4.3%) and transient anal bleeding (3.7%). The treatment was effective in 86% of patients after a mean follow-up of 32 months. Efficacy was high for grades I and II (100% and 97.4% ) but decreased for grade III (69.8%; p<0.001) and grade IV (0%; p<0.001). Most relapses occurred within the first 24 months (87%) and were not significantly related to age, gender, duration of symptoms, itching, bleeding, pain, tenesmus or bowel habit, but were significantly related to the presence of prolapse and its grade (p<0.001), and to the involvement of left posterior, right lateral and anterior pedicles (p<0.05).
ambulatory RBL is a safe and effective treatment for grade I, II and III symptomatic haemorrhoids, and is associated with low morbidity. Recurrence is uncommon and occurs mainly within the first 24 months, being related to the presence and grade of prolapse as well as to its location, but bears little relation to the rest of factors analysed.
评估门诊橡皮圈套扎术（RBL）治疗有症状内痔的有效性，并确定与复发相关的因素。
对1996年11月至2000年11月在门诊接受橡皮圈套扎术治疗有症状痔疮（I - III级或有严重手术禁忌证的IV级）的232例患者进行前瞻性研究。使用Stille AB（Comedic）套扎器和吸引泵进行套扎，每次放置1 - 3个橡皮圈，每位患者最多进行3次套扎。治疗有效性定义为无症状，并通过肛门镜检查垫分离后的残留瘢痕来确认。分类变量采用卡方检验进行比较，连续变量采用学生t检验。采用逻辑回归分析确定与复发相关的临床因素。
163例完成随访的患者（70%）在235次治疗中共放置了331个橡皮圈。平均年龄为45.6岁，男性占64.4%。大多数患者（86.5%）患有II级或III级痔疮。总体发病率为6%。最常见的并发症是直肠坠胀感（11%）、轻度或中度肛门疼痛（7.4%）、排尿困难（4.3%）和短暂性肛门出血（3.7%）。平均随访32个月后，86%的患者治疗有效。I级和II级的有效率较高（分别为100%和97.4%），但III级（69.8%；p<0.001）和IV级（0%；p<0.001）的有效率下降。大多数复发发生在最初24个月内（87%），与年龄、性别、症状持续时间、瘙痒、出血、疼痛、坠胀感或排便习惯无显著相关性，但与脱垂的存在及其分级（p<0.001）以及左后、右外侧和前蒂的受累情况（p<0.05）显著相关。
门诊橡皮圈套扎术是治疗I、II和III级有症状痔疮的一种安全有效的方法，且发病率较低。复发不常见，主要发生在最初24个月内，与脱垂的存在、分级及其位置有关，但与所分析的其他因素关系不大。
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