Department of Surgery, University of California, San Diego, San Diego, CA, USA.
Surg Endosc. 2012 Nov;26(11):3082-7. doi: 10.1007/s00464-012-2325-1. Epub 2012 May 31.
A novel endoscopic delivery system for infrared coagulation therapy (IRC) has been designed recently. IRC is a well-established treatment for symptomatic internal hemorrhoids. Patients frequently undergo lower endoscopy before hemorrhoid treatment to eliminate other sources of bleeding. Current treatment options are difficult to perform without an anal retractor, adequate lighting, and specialized instruments. Endoscopic IRC is an attractive alternative to standard IRC, because it can be performed during the lower endoscopy.
Endoscopic IRC utilizes infrared radiation generated by a control box, which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared Coagulator™). The light guide is placed through the colonoscope or flexible sigmoidoscope in the same chamber as other endoscopic instruments.
A retrospective review was performed using a prospectively collected database. A standardized protocol was utilized in all patients. Patients graded their symptoms before and after therapy by using the visual analog symptom severity scoring system (range, 0-10). These results were analyzed by using the nonparametric Wilcoxon signed-rank test. Exact P values were computed by using the R function wilcox.exact.
A total of 55 patients underwent endoscopic IRC for predominately grade II and grade III symptomatic internal hemorrhoids (71 %). There were 22 (40 %) female patients. Posttherapy results indicated a significant improvement in global symptoms (pretreatment average global score = 2.24 vs. posttreatment average global score = 0.28; P < 0.0001). There have been no adverse events reported to date.
Endoscopic IRC provides improved visibility and efficiency, allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of lower endoscopy. Patients experienced significant improvement in their symptoms after a single session of endoscopic IRC. There are a variety of additional endoscopic IRC therapeutic utilities: endoscopic management of angiodysplasia, inflammation, hemostasis, and NOTES applications.
最近设计了一种用于红外凝固治疗（IRC）的新型内镜输送系统。IRC 是治疗症状性内痔的成熟疗法。在痔治疗前，患者经常进行下内窥镜检查以消除其他出血源。目前的治疗选择在没有肛门牵开器、足够的照明和专门仪器的情况下难以进行。内镜 IRC 是标准 IRC 的一种有吸引力的替代方案，因为它可以在下内窥镜检查期间进行。
内镜 IRC 利用控制箱产生的红外辐射，通过柔性光纤光导（精密内镜红外凝固器™）施加到组织上。光导通过结肠镜或软性乙状结肠镜放置在与其他内镜仪器相同的腔室内。
使用前瞻性收集的数据库进行回顾性审查。所有患者均采用标准化方案。患者在治疗前后使用视觉模拟症状严重程度评分系统（范围 0-10）对症状进行评分。通过非参数 Wilcoxon 符号秩检验分析这些结果。使用 R 函数 wilcox.exact 计算确切的 P 值。
共有 55 例患者因主要为 II 级和 III 级症状性内痔（71%）接受内镜 IRC 治疗。有 22 名（40%）女性患者。治疗后结果表明整体症状显著改善（治疗前平均整体评分=2.24 与治疗后平均整体评分=0.28；P<0.0001）。迄今为止，尚未报告任何不良事件。
内镜 IRC 提供了更好的可视性和效率，允许在下内窥镜检查时同时治疗症状性内痔。患者在接受单次内镜 IRC 治疗后症状显著改善。内镜 IRC 还具有多种治疗用途：内镜治疗血管发育不良、炎症、止血和NOTES 应用。
