Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland.
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Colorectal Dis. 2019 Jun;21(6):689-696. doi: 10.1111/codi.14572. Epub 2019 Feb 20.
Laser haemorrhoidoplasty is associated with minimal postoperative pain and good symptom improvement in the short-term. However, less is known about its long-term efficacy. This study aims to determine the short- and long-term outcomes of laser haemorrhoidoplasty.
Between October 2010 and May 2012, 50 consecutive patients with grade II-III haemorrhoids were treated with laser haemorrhoidoplasty. Short-term follow-up was assessed on days 1, 30 and 60 and long-term follow-up was at 5 years (haemorrhoidal stage reduction, pain, patient satisfaction, symptom improvement, incapacity for work, continence, complications, recurrence).
Short-term follow-up was achieved for all patients and long-term follow-up for 44/50 patients (88%). At short-term follow-up, haemorrhoidal stage reduction was documented in 49 (98%) patients. Complete or good symptom improvement was reported by 36/50 (72%) and 10/50 patients (20%) at 60 days. Postoperative complications occurred in 9/50 patients (18%) with three Clavien-Dindo grade IIIb complications (two fistulas, one incontinence), one grade IIIa (perianal thrombosis) and five grade I (one perianal thrombosis, two perianal eczema, one local bleeding, one anal fissure). Postoperative pain was low (visual analogue scale 0-1) at day 1 in 37/50 (74%), at day 30 in 47/50 (94%) and at day 60 in 50/50 patients (100%). After a mean follow-up of 5.4 years (SD 5.4 months) the recurrence rate was 34% (15/44 patients) with a median time to recurrence of 21 months (range 0.2-6 years).
Although laser haemorrhoidoplasty achieves a high short-term success rate with respect to stage reduction and symptom improvement, it is associated with a high rate of minor postoperative complications and long-term recurrence. Therefore, laser haemorrhoidoplasty should be used with caution.
激光痔疮切除术在短期内与术后疼痛最小和良好的症状改善相关。然而，其长期疗效知之甚少。本研究旨在确定激光痔疮切除术的短期和长期疗效。
2010 年 10 月至 2012 年 5 月，50 例 II-III 度痔患者接受了激光痔疮切除术。短期随访评估在第 1、30 和 60 天进行，长期随访在 5 年时进行（痔分期降低、疼痛、患者满意度、症状改善、工作能力丧失、控便能力、并发症、复发）。
所有患者均完成了短期随访，44/50 例（88%）患者完成了长期随访。短期随访时，49 例（98%）患者痔分期降低。36/50 例（72%）和 10/50 例（20%）患者在 60 天时有完全或良好的症状改善。50 例患者中有 9 例（18%）发生术后并发症，其中 3 例为 Clavien-Dindo IIIb 级并发症（2 例瘘管，1 例失禁），1 例为 IIIa 级（肛周血栓形成），5 例为 I 级（1 例肛周血栓形成，2 例肛周湿疹，1 例局部出血，1 例肛裂）。术后第 1 天 37/50 例（74%）、第 30 天 47/50 例（94%）和第 60 天 50/50 例（100%）患者疼痛较轻（视觉模拟评分 0-1）。平均随访 5.4 年后（SD 5.4 个月），复发率为 34%（15/44 例），复发中位时间为 21 个月（范围 0.2-6 年）。
尽管激光痔疮切除术在降低痔分期和改善症状方面具有较高的短期成功率，但与较高的术后并发症和长期复发率相关。因此，激光痔疮切除术应谨慎使用。
