Department of General Surgery, Hospital S. Spirito, Bra (CN), Via Vittorio Emanuele 3, 12042, Bra, CN, Italy.
Surg Endosc. 2011 May;25(5):1369-75. doi: 10.1007/s00464-010-1370-x. Epub 2010 Oct 26.
According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode laser-pulsed shot causes shrinkage of tissue. The depth of shrinkage can be regulated by the power and duration of the laser beam. Through a 1000-micron conic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. Terminal branches of the superior hemorrhoidal artery in the anal canal, if precisely identified through a Doppler signal, can be closed with the use of this laser.
A specially designed proctoscope has a small window that allows introducing a Doppler probe whose function is to identify hemorrhoidal arteries. Approximately 3 cm above the dentate line, the terminal branches of the superior hemorrhoidal artery (usually 8-12) are recognized through a clockwise rotation of the proctoscope and progressively fulgurated through a laser optic fiber. The procedure does not require anesthesia and can be performed as an ambulatory treatment.
Thirty patients (16 men) with second to third grade symptomatic hemorrhoids have been treated with the described technique. The procedure proved to be successful at 3 months' follow-up in 92% of cases. No major adverse effects or complications were reported. Bleeding was observed in four cases. In two cases surgical hemostasis was necessary. Minor pain that required medication was reported in three cases.
The hemorrhoidal laser procedure (HeLP) represents a new nonexcisional, mini-invasive treatment for patients suffering from second and third degree hemorrhoids without severe mucosal prolapse. Thermal occlusion of the hemorrhoidal arteries causes a progressive shrinkage of hemorrhoidal cushions. The procedure does not require anesthesia, is technically easy, repeatable, and can be performed as an office treatment.
根据“血管”理论，直肠上动脉的动脉溢出会导致痔静脉丛扩张。980nm 半导体激光脉冲射击会导致组织收缩。收缩的深度可以通过激光束的功率和持续时间来调节。通过一根 1000 微米的锥形光纤，五次激光射击，功率为 13W，持续时间为 1.2 秒，间隔 0.6 秒，可以将组织收缩到大约 5 毫米的深度。如果通过多普勒信号精确识别肛门内的直肠上动脉终末支，可以使用这种激光将其封闭。
一种专门设计的直肠镜有一个小窗口，可以插入一个多普勒探头，其功能是识别痔动脉。在齿状线以上约 3 厘米处，通过直肠镜的顺时针旋转识别直肠上动脉的终末支（通常为 8-12 支），并通过激光光纤逐渐烧灼。该过程不需要麻醉，可以作为门诊治疗进行。
30 名（16 名男性）第二至三度有症状的痔患者接受了上述技术治疗。在 3 个月的随访中，92%的患者手术成功。未报告重大不良影响或并发症。有 4 例出现出血。在 2 例中需要手术止血。有 3 例报告轻微疼痛，需要药物治疗。
痔激光手术（HeLP）是一种新的非切除、微创治疗方法，适用于第二和第三度痔患者，无严重黏膜脱垂。痔动脉的热闭塞导致痔垫的逐渐收缩。该过程不需要麻醉，技术上简单、可重复，可作为门诊治疗。
