Plapler Hélio, Hage Raduan, Duarte Janaina, Lopes Nilza, Masson Igor, Cazarini Cláudio, Fukuda Thiago
Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Photomed Laser Surg. 2009 Oct;27(5):819-23. doi: 10.1089/pho.2008.2368.
This study aimed to describe the clinical results of intrahemorrhoidal application of a diode laser.
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.
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, 5 W, frequency of 5 Hz, energy density of 19 J/cm(2), total energy of 4-10 J).
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.
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.
本研究旨在描述二极管激光内痔内应用的临床结果。
痔疮是常见的疼痛来源，尚无手术技术能实现无痛治疗效果。一项实验研究中描述的用于静脉曲张的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较少。
15例二度和三度痔疮患者接受了内痔激光治疗。确定痔核后，将光纤插入每个痔核，并对其进行激光能量照射（810纳米，5瓦，频率5赫兹，能量密度19焦/平方厘米，总能量4 - 10焦）。
痔核立即部分缩小，术后7、14、21和28天的临床检查显示，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。在整个研究期间，通过视觉模拟量表（0 - 10）测量的平均疼痛强度为0.84±1.13（平均值±标准差）。主要并发症为烧伤性病变（4例）和残余皮垂（皮赘）（5例）。10例对照患者接受了开放性“冷刀”痔切除术。他们的疼痛强度为1.78±0.68（平均值±标准差）。两组之间存在显著统计学差异（p = 0.018）。
与开放性痔切除术相比，向中小痔核输送二极管激光能量引起的疼痛较小，并在短时间内导致部分至完全缓解。必须进行一些调整以防止烧伤性病变和残余皮垂。尽管该技术对大痔核不是一种好方法，但它为痔疮疾病的手术治疗开辟了新的可能性。
