长度为1940 nm的二极管激光治疗痔疮的机会

S. Frolov, A. M. Kuzminov, D. V. Vyshegorodtsev, O. A. Mainovskaya, Y. L. Trubacheva, O. Fomenko, V. Korolik, I. S. Bogormistrov, I. A. Mukhin, A. M. Battalova, E. Bogdanova
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引用次数: 2

摘要

目的:提高波长为1940 nm的二极管激光治疗二、三期痔疮患者的效果。材料和方法。该研究包括28例二期或三期痔疮患者。一种基于使用波长为1940 nm的二极管激光器的新治疗方法应用于所有患者。这种技术(激光痔疮成形术)提供了激光辐射对内痔结海绵状组织和直肠上动脉末端分支的热效应。评估术后疼痛综合征的强度,研究术前、术后痔疮疾病表现的临床症状。为了研究该方法的有效性并评估激光辐射的热暴露深度,我们进行了经直肠超声多普勒和病理形态学检查。采用括约肌测量法评估直肠锁定器术前和术后的功能状态。根据SF - 36问卷调查,对激光痔疮成形术患者的生活质量进行了研究。手术干预在局麻和脊髓麻醉下进行。术中出现痔结出血并发症3例。术后早期诊断外痔炎性水肿4例。疼痛综合征的强度在VAS量表上进行评估,到第7天,93%的患者的疼痛强度不超过1分。28例患者均在术后1 ~ 6个月内随访。所有患者均无痔疮症状,无复发。经直肠超声加多普勒成像,可以诊断出沿直肠上动脉末端分支的血流减少2 - 3倍,手术前早期确定的内痔,在手术后1个月尚未可见。经括约肌测量,28例患者均未发现违反肛门保留功能。使用波长为1940 nm的二极管激光手术治疗第二、第三期痔疮。适当的技术性能和最佳能量的选择,可以达到良好的临床效果。建议的干预方法确保没有明显的疼痛综合征,这不会导致术后早期生活质量的显着下降,并且可以缩短劳动康复期。激光痔疮成形术是治疗2期和3期痔疮的一种非常有效的方法,并开辟了在门诊治疗的可能性。
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The Opportunity of Using Diode Laser with the Length of 1940 nm in the Treatment of Hemorrhoids
Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis. 
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CiteScore
1.90
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0.00%
发文量
44
审稿时长
8 weeks
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