RU2436537C2 - Method of treating hemorrhoid - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery and can be applied for treatment of hemorrhoid. Destruction of hemorrhoidal bolus is performed with hollow shapened needle with located into lumen movable light-conductor. Needle is connected by flexible fibre-optic cable with source of laser irradiation. Needle is introduced together with light-conductor into hemorrhoidal bolus at 0.5-1.5 cm. Hollow sharpened needle is brought away from distal end of light-conductor at 2-6 mm or light-conductor is introduced into tissue of hemorroidal bolus 2-6 mm more distally than sharpened needle tip. Exposition is selected depending on volume of coagulated tissue and thermal destruction is carried out by laser impact on tissues of hemorrhoidal bolus in pulse mode 500/500 ms with power 3-4 W.

EFFECT: method makes it possible to prevent development of anal canal strictures, reduce probability of bleeding in early postoperative period, reduce pain syndrome.

3 cl, 2 ex, 1 dwg

Description

The invention relates to medicine and can be used for hyperthermic (laser) destruction of hemorrhoids in an outpatient setting.

The use of lasers for the treatment of hemorrhoids is known.

For example, there is a known method for the surgical treatment of hemorrhoids, including the withdrawal of the main hemorrhoidal nodes, clamping and cutting off the nodes with a laser beam along the clamp at a distance of at least one millimeter (SU 1779336 A1, 12/07/1992). Laser cutting off of the hemorrhoid helps reduce intraoperative and postoperative complications due to the use of a conventional cutting surgical instrument during surgery. However, the traumatic effect of the laser on the operated tissues does not exclude their infection.

Another example is the treatment of hemorrhoids, in which laser irradiation of the perianal region is carried out for 7-10 minutes before and after electrosurgical surgery (RU 2188027 C2, 08.27.2002). The electrosurgical effect on the tissue does not lead to the destruction of the hemorrhoid.

The closest to the proposed invention should be considered a method of treating hemorrhoids, in which such destruction is carried out by means of a cooled cryo-instrument in stationary and outpatient conditions (RU 2296528 C2, 04/10/2007).

However, cryogenic destruction is a multi-stage treatment carried out with an interval of 1.5-2 months. At each stage, one or two of the largest hemorrhoidal nodes is destroyed, and four freezing cycles are carried out.

The objective of the present invention is the treatment of hemorrhoids on an outpatient basis without suture material, without local anesthesia and narcotic analgesics with minimal damaging effect on the mucous membrane of the internal hemorrhoids and internal sphincter.

The technical result of the method is to prevent the development of strictures of the anal canal and reduce the likelihood of bleeding in the early postoperative period, as well as a significant decrease in the intensity of the inflammatory reaction and postoperative pain due to the absence of postoperative wounds and open areas of coagulation necrosis. The method allows to reduce the time of surgery and the volume of damaged tissue, does not require long-term observation in the early postoperative period, provides prophylaxis of infection of the rectal wall and reduces the likelihood of developing purulent complications, and its asepticity (high temperature in the affected area) reduces the likelihood of developing purulent complications.

The invention is expressed in the aggregate of essential features, in which the method of treating hemorrhoids includes the destruction of hemorrhoids and differs from the closest analogue in that the anal canal is revised using an anoscope, and the destruction of the hemorrhoids is carried out under the control of the anoscope with a hollow pointed needle with a movable fiber placed in the lumen moreover, the needle is connected with a flexible fiber-optic cable to a laser radiation source and, together with the light guide, is inserted into the hemorrhoid by 0.5-1.5 m, then the hollow pointed needle is retracted 2-6 mm from the distal end of the fiber or the fiber is inserted into the hemorrhoidal tissue 2-6 mm distal to the pointed end of the needle, and then the exposure is selected depending on the volume of the coagulated tissue and thermal destruction is carried out by laser exposure on hemorrhoidal tissue in a pulsed mode 500/500 ms with a power of 3-4 watts.

Depending on the volume of coagulated tissue, laser irradiation is carried out from 30 s to 5 min.

The gap between the light guide and the tube is equal to 1/3 to 2/3 of the wall thickness of the tube.

The essence of the method is illustrated in the drawing with the image of a hollow pointed needle with a movable light guide in the lumen inserted into the hemorrhoid.

The method is as follows.

The patient is in a proctological chair.

Revision of the anal canal and destruction of the hemorrhoidal node 3 is carried out using an anoscope. A pre-hollow pointed needle 1 with a movable optical fiber 2 located in the lumen is connected by a flexible fiber-optic cable to a laser radiation source having a wavelength of from 0.96 to 2.91 μm. Then, the hollow pointed needle 1 along with the movable fiber 2 is inserted into the hemorrhoidal node 3 by 0.5-1.5 cm. Then the hollow pointed needle 1 is retracted 2-6 mm from the distal end of the fiber 2 or the fiber 2 is inserted into the tissue of the hemorrhoid 3 2-6 mm distal to the pointed end of the needle 1. Next, select the exposure depending on the volume of coagulated tissue and carry out thermal destruction by laser exposure of the hemorrhoidal tissue 3 in a pulsed mode 500/500 ms with a power of 3-4 watts.

Depending on the volume of coagulated tissue of the hemorrhoid 3, laser irradiation is carried out from 30 s to 5 min.

Example 1: patient K., age 44 years. Diagnosis: chronic combined hemorrhoids.

Under local anesthesia, anus deviation was performed. Significantly increased external and internal hemorrhoids at 3, 7, 8, and 11 hours are palpation dense, purplish-cyanotic color, rigid. With the help of an anoscope, the anal canal was revised - a hemorrhoidal node was removed into the anoscope window at 7 o'clock. A hollow pointed needle with a laser fiber placed inside, connected by a flexible fiber-optic cable to the MILON LAHTA programmable surgical device for photodynamic and hyperthermic exposure modes (model 810.4.5. With direct radiation output SMA Q / Q 200/230 WF), is introduced into 1.0 cm hemorrhoid under visual control. Then the needle is retracted 4 mm from the distal end of the optical fiber located in the tissue site. The thermal destruction of the unit was performed in a pulsed mode 500/500 ms, with a power of 3.5 watts. Similarly performed laser destruction of nodes at 8, 11 and 3 hours. The destruction time of one node ranged from 2 to 3.5 minutes No bleeding was noted. Treatment of the operation area with an anesthetic gel.

Example 2: patient Y., age 41 years. Diagnosis: chronic combined hemorrhoids.

Under local anesthesia, anus deviation was performed. Significantly increased external and internal hemorrhoids at 3-7-11 hours, palpation dense, purplish-cyanotic color, rigid. With the help of an anoscope, the anal canal was revised - a hemorrhoidal node at 3 o'clock was displayed in the anoscope window. A hollow pointed needle with a laser fiber placed inside, connected by a flexible fiber-optic cable to the MILON LAHTA programmable surgical device for photodynamic and hyperthermic exposure modes (model 810.4.5. With direct radiation output SMA Q / Q 200/230 WF), is introduced into 1.0 cm hemorrhoid under visual control. The optical fiber is moved 3 mm distal to the pointed end of the needle into the tissue of the node by translational motion. The thermal destruction of the unit was performed in a pulsed mode 500/500 ms, with a power of 3.5 watts. Similarly performed laser destruction of nodes at 7 and 11 hours. The destruction time of one node ranged from 1.5 to 3 minutes. No bleeding noted. Treatment of the operation area with an anesthetic gel.

Claims (3)

1. A method of treating hemorrhoids, including the destruction of hemorrhoidal nodes, characterized in that the anal canal is revised using an anoscope, and the destruction of the hemorrhoid is carried out under the control of an anoscope with a hollow pointed needle with a movable light guide placed in the lumen, and the needle is connected with a flexible optical fiber cable to a laser radiation source and together with the light guide is injected into the hemorrhoid by 0.5-1.5 cm, then the hollow pointed needle is taken back 2-6 mm from the distal end of the light guide or the light guide is introduced into the tissue of the hemorrhoidal node 2-6 mm distal to the pointed end of the needle, and then the exposure is selected depending on the volume of the coagulated tissue and thermal destruction is carried out by laser exposure of the hemorrhoidal tissue in a pulsed mode 500/500 ms with a power of 3-4 watts. 2. The method according to claim 1, characterized in that the laser exposure is carried out from 30 s to 5 minutes 3. The method according to claim 1, characterized in that the gap between the optical fiber and the tube is equal to from 1/3 to 2/3 of the wall thickness of the tube.

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