Fernandes Vítor, Fonseca Jorge
Clínica de Gastrenterologia de Almada, Almada, Portugal.
Clínica CUF Almada, Monte da Caparica, Portugal.
GE Port J Gastroenterol. 2019 May;26(3):169-175. doi: 10.1159/000492202. Epub 2018 Aug 31.
Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed.
We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) recruited over 6 years. Foam injection was performed in one to four sessions with polidocanol 2%: 10 mL of the mixture (2 mL liquid plus air) or 20 mL (4 mL liquid plus air). The number of sessions and amount of foam injected depended on initial hemorrhoid size, compliance to receive foam, and clinical response. The mixture, prepared using a three-way tap connected to two 10/20-mL syringes, was injected immediately after preparation using an intravenous needle. The primary endpoint was self-reported satisfaction without major complications at 4 weeks.
Efficacy was very high, with 1,957 patients (98%) reporting satisfaction regarding blood loss control and prolapse reduction. The procedure was well tolerated: 1,838 patients (92%) presented mild/no pain. Objective reduction of prolapse volume was documented in 86% of reobserved cases. Complications were rare and usually minor: only 3 cases of clinically significant bleeding (0.15%), 2 of whom were on dual antiplatelet therapy plus oral anticoagulation, 2 cases of rectal abscess, 8 hemorrhoid thromboses, and 1 urinary retention requiring catheter (0.7% severe complications).
Treatment of internal hemorrhoids with polidocanol foam injected in high doses is very effective and safe for the control of blood loss and prolapse, even for patients on anticoagulation/antiplatelet treatment.
痔病很常见。本研究旨在评估使用静脉注射针高剂量注射聚多卡醇泡沫治疗脱垂或出血的有症状内痔的疗效和安全性。
我们评估了连续6年招募的2000例脱垂性痔(II/III/IV级)患者。使用2%聚多卡醇进行一至四次泡沫注射:10毫升混合物(2毫升液体加空气)或20毫升(4毫升液体加空气)。注射次数和泡沫注射量取决于初始痔大小、接受泡沫的依从性和临床反应。使用连接到两个10/20毫升注射器的三通阀制备混合物,制备后立即使用静脉注射针进行注射。主要终点是4周时自我报告的无重大并发症的满意度。
疗效非常高,1957例患者(98%)报告对失血控制和脱垂减轻感到满意。该操作耐受性良好:1838例患者(92%)出现轻度/无疼痛。在86%的再次观察病例中记录到脱垂体积客观减小。并发症罕见且通常较轻微:仅3例有临床意义的出血(0.15%),其中2例正在接受双联抗血小板治疗加口服抗凝治疗,2例直肠脓肿,8例痔血栓形成,1例需要导尿的尿潴留(0.7%严重并发症)。
高剂量注射聚多卡醇泡沫治疗内痔对控制失血和脱垂非常有效且安全,即使对抗凝/抗血小板治疗的患者也是如此。