Department of General Surgery, Hospital Santo Spirito, Bra (Cuneo), Italy.
Dis Colon Rectum. 2011 Jun;54(6):693-8. doi: 10.1007/DCR.0b013e3182112d58.
Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation.
Our aim was to compare the hemorrhoid laser procedure with rubber band ligation for outpatient treatment of symptomatic hemorrhoids with moderate mucosal prolapse.
This was a randomized controlled trial with balanced allocation to hemorrhoid laser procedure or rubber band ligation, with stratification by study center.
This study was conducted at 2 teaching hospitals in Italy.
Patients with symptomatic grade II or grade III hemorrhoids with minimal mucosal prolapse were eligible for the study.
In the hemorrhoid laser procedure operation, a Doppler probe was inserted into the anal canal through a dedicated disposable proctoscope to identify the terminal branches of superior hemorrhoidal arteries approximately 3 cm above the dentate line. Five pulsed laser shots were delivered to each identified artery through the proctoscope to close the terminal branches. The procedure was repeated for each artery through clockwise rotation of the proctoscope. Absence of a Doppler signal after treatment confirmed arterial coagulation. Rubber band ligation was performed by positioning rubber bands at the base of left lateral, right anterior, and right posterior piles. No anesthesia was given for either technique.
Operative time, complications, postoperative pain (visual analog scale), postoperative downgrading of hemorrhoids, resolution of symptoms, and quality of life were evaluated.
A total of 60 patients (35 women, 25 men; mean age, 46 years) entered the trial and were analyzed. No significant differences between rubber band ligation and hemorrhoid laser procedure were observed in operative time or intraoperative morbidity. The median postoperative pain score was 2.9 (range, 1-5) with rubber band ligation vs 1.1 (range, 0-2) for hemorrhoid laser procedure (P < .001). At 6 months, resolution of symptoms was observed in 16 patients (53%) with ligation vs 27 (90%) with hemorrhoid laser procedure (P < .001), and reduction of hemorrhoids by at least 1 grade was observed in 12 patients (40%) with ligation vs 24 (80%) with hemorrhoid laser procedure (P < .001). Significantly higher quality of life was seen in the hemorrhoid laser procedure group (P = .002).
Follow-up was not longer than 1 year (median, 6 mo).
Despite higher cost, the hemorrhoid laser procedure technique was more effective than rubber band ligation in reducing postoperative pain, resolving symptoms, and improving quality of life in patients with grade II or III hemorrhoids with incomplete mucosal prolapse.
痔激光治疗是一种新的激光治疗方法，用于门诊治疗痔，通过多普勒引导的激光凝固来阻断痔动脉血流供应痔丛。
我们旨在比较痔激光治疗与橡皮圈结扎治疗伴有中度黏膜脱垂的症状性痔的效果。
这是一项随机对照试验，采用平衡分配的方法，将患者分为痔激光治疗组或橡皮圈结扎组，并按研究中心进行分层。
该研究在意大利的 2 所教学医院进行。
患有症状性 II 级或 III 级痔，伴有最小程度黏膜脱垂的患者符合研究条件。
在痔激光治疗手术中，将多普勒探头通过专用一次性直肠镜插入肛管，以识别齿状线以上约 3cm 处的直肠上动脉终末分支。通过直肠镜向每个识别出的动脉发射 5 个脉冲激光束，以闭合终末分支。通过直肠镜顺时针旋转，对每个动脉重复进行此操作。治疗后多普勒信号消失证实动脉已凝固。橡皮圈结扎是通过在左侧外侧、右侧前侧和右侧后侧痔的基部定位橡皮圈来进行的。两种技术均不给予麻醉。
手术时间、并发症、术后疼痛（视觉模拟评分）、术后痔降级、症状缓解和生活质量。
共有 60 名患者（35 名女性，25 名男性；平均年龄 46 岁）入组并进行了分析。在手术时间或术中发病率方面，橡皮圈结扎与痔激光治疗之间无显著差异。橡皮圈结扎的中位术后疼痛评分为 2.9（范围 1-5），而痔激光治疗为 1.1（范围 0-2）（P<0.001）。在 6 个月时，结扎组有 16 名患者（53%）症状缓解，而痔激光治疗组有 27 名患者（90%）（P<0.001）；结扎组有 12 名患者（40%）痔降级至少 1 级，而痔激光治疗组有 24 名患者（80%）（P<0.001）。痔激光治疗组的生活质量显著提高（P=0.002）。
随访时间不超过 1 年（中位数 6 个月）。
尽管痔激光治疗的成本更高，但与橡皮圈结扎相比，它在减轻术后疼痛、缓解症状和提高生活质量方面更为有效，适用于伴有不完全黏膜脱垂的 II 级或 III 级痔患者。
