درمان هموروئيد داخلي با حلقة لاستيكي مطالعه و بررسي نتايج در پنجاه بيمار

Rubber Band Ligation in Treatment of Internal Hemorrhoid Study and Assessment of the Results in 50 Patients

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺩﺭﻣﺎﻥ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ ﺑﺎ ﺣﻠﻘﻪ ﻳﮏ ﺭﻭﺵ ﺳﺮﭘﺎﻳﻲ ﻣﺤﺴـﻮﺏ ﻣﻲ ﺷﻮﺩ، ﮐﻪ ﺳﺒﺐ ﻧﮑـﺮﻭﺯ ﭘﺎﮐﻪ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﻭ ﺩﻓـﻊ ﺁﻥ ﻣﻲ ﮔﺮﺩﺩ. ﻣﻄﺎﻟﻌﺔ ﺁﻳﻨﺪﻩ ﻧﮕـﺮ ﺩﺭﻣﺎﻥ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺣﻠﻘﺔ ﻻﺳﺘﻴﮑﻲ ﻭ ﺑﺮﺭﺳﻲ ﻧﺘﺎﻳﺞ ﺍﻳﻦ ﺭﻭﺵ ﺩﺭﻣـﺎﻧﻲ ﻭ ﻣﻘﺎﻳﺴﻪ ﺁﻥ ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﺮﺍﮐﺰ ﺩﻳﮕﺮ ﮐﺸﻮﺭﻫﺎﻱ ﺩﻧﻴﺎ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻓﺮﺍﺩ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﺑﻴﻦ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺑﺎ ﻋﻼﺋﻢ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠـﻲ ﺑﻪ ﮐﻠﻴﻨﻴـﮏ ﮐـﻮﻟﻮﺭﮐﺘﺎﻝ ﻣﺠﺘﻤـﻊ ﺣﻀﺮﺕ ﺭﺳﻮﻝ)ﺹ(، ﻳﺎ ﮐﻠﻴﻨﻴﮏ ﺷﺨﺼﻲ ﻣﺮﺍﺟﻌﻪ ﻧﻤﻮﺩﻩ ﺑﻮﺩﻧﺪ، ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﺍﻧﺪ. ﺑﻴﻤـﺎﺭﺍﻥ ﺍﻧﺘﺨـﺎﺏ ﺷﺪﻩ، ﺑﻴﻦ ﺩﺭﺟﻪ 1 ﺗﺎ 3 ﻫﻤﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ ﻋﻼﻣﺖ ﺩﺍﺭ ﮐﻪ ﺑﻴﺸﺘـﺮﻳﻦ ﺁﻧﻬﺎ ﺷﮑﺎﻳـﺖ ﺍﺯ ﺧـﻮﻧﺮﻳﺰﻱ ﺩﺍﺷﺘﻨـﺪ، ﺑـﻮﺩﻩ ﺍﺳﺖ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﺁﺑـﺎﻥ ﻣﺎﻩ 1383 ﺗﺎ ﻓﺮﻭﺭﺩﻳﻦ 1385 ﺍﻧﺠﺎﻡ ﮔﺮﻓﺘﻪ ﻭ ﺗﻌﺪﺍﺩ ﭘﻨﺠﺎﻩ ﺑﻴﻤﺎﺭ ﮐﻪ ﺑﺎ ﺍﻳﻦ ﺭﻭﺵ ﺩﺭﻣـﺎﻥ ﺷﺪﻩ ﺍﻧﺪ، ﺟﻬـﺖ ﺑﺮﺭﺳﻲ ﺍﻧﺘﺨﺎﺏ ﻧﻤﻮﺩﻩ ﺍﻳﻢ. ﺑﺮﺍﻱ ﺍﻳﻦ ﺭﻭﺵ ﻳﺎ ﺍﺯ ﺩﺳﺘﮕﺎﻩ McGiveny ﻭ ﻳﺎ ﺍﺯ ﺩﺳﺘﮕﺎﻩ ﻳﮏ ﺑﺎﺭ ﻣﺼﺮﻑ O'Regan ﺍﺳﺘﻔـﺎﺩﻩ ﺷـﺪﻩ ﺍﺳﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ ﺗﻌـﺪﺍﺩ ﭘﻨﺠـﺎﻩ ﺑﻴﻤﺎﺭ ﺑﻪ ﺗﺮﺗﻴﺐ، 35 ﻣﻮﺭﺩ ﺩﺭ ﺩﺭﺟﺔ 2 ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ، 10 ﻣـﻮﺭﺩ ﺩﺭ ﺩﺭﺟﺔ 3 ﻭ 5 ﻣـﻮﺭﺩ ﻧﻴﺰ ﺩﺭ ﺩﺭﺟﺔ 1 ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ ﻗـﺮﺍﺭ ﺩﺍﺷﺘﻨﺪ. 6 ﻣﺎﻩ ﭘﻴﮕﻴـﺮﻱ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺑﺮﺍﻱ ﺑﺮﺭﺳﻲ ﻧﺘﺎﻳﺞ ﺩﺭ ﻧﻈﺮ ﮔـﺮﻓﺘﻪ ﺷـﺪﻩ ﺍﺳﺖ. ﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤـﻞ ﺑﻪ ﺗﺮﺗﻴﺐ ﺯﻳﺮ ﺑـﻮﺩﻩ ﺍﺳﺖ: 36 ﺑﻴﻤـﺎﺭ ﺍﺯ 50 ﻣـﻮﺭﺩ ﻫﻴـﭻ ﺩﺭﺩﻱ ﻧﺪﺍﺷﺘﻨـﺪ. 13 ﺑﻴﻤـﺎﺭ ﺩﺭﺩ ﻣﺘﻮﺳـﻂ ﻭ 1 ﻣـﻮﺭﺩ ﺩﺭﺩ ﺷﺪﻳﺪ ﺩﺍﺷﺘﻨﺪ. ﺍﺯ ﻧﻈـﺮ ﺭﺿﺎﻳﺘﻤﻨـﺪﻱ ﺍﺯ ﺍﻳﻦ ﺭﻭﺵ ﺩﺭﻣـﺎﻧﻲ، ﺑﻴﻤـﺎﺭﺍﻥ ﺑﻪ ﺳﻪ ﮔـﺮﻭﻩ ﺗﻘﺴﻴـﻢ ﺷـﺪﻧﺪ، ﮔـﺮﻭﻩ ﺍﻭﻝ، ﻫﻴـﭻ ﺗﻐﻴﻴـﺮ ﻭ ﺑﻬﺒﻮﺩﻱ ﺍﺯ ﺍﻳﻦ ﻋﻤـﻞ ﺩﺭ ﺁﻧﻬﺎ ﺣﺎﺻﻞ ﻧﺸﺪﻩ ﺍﺳﺖ ﮐﻪ 1 ﻣـﻮﺭﺩ ﺍﺯ ﻛﻞ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻮﺩ ﮔـﺮﻭﻩ ﺩﻭﻡ، ﺍﻓـﺮﺍﺩﻱ ﮐﻪ ﺭﺿﺎﻳﺖ ﻣﻨﺪﻱ ﻧﺴﺒـﻲ ﺭﺍ ﺑﻴـﺎﻥ ﻣﻲ ﮐﺮﺩﻧﺪ 2 ﻣﻮﺭﺩ ﺍﺯ ﮐﻞ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻮﺩﻧﺪ ﻭ ﮔـﺮﻭﻩ ﺳﻮﻡ، ﺭﺿﺎﻳﺖ ﮐﺎﻣﻞ ﺍﺯ ﻧﺘﻴـﺠﺔ ﺩﺭﻣـﺎﻥ ﺩﺍﺷﺘﻨﺪ ﮐﻪ 47 ﺑﻴﻤـﺎﺭ ﺍﺯ ﮐـﻞ 50 ﺑﻴﻤـﺎﺭﺍﻥ ﺑـﻮﺩﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ ﻣﻄﻠـﻮﺏ ﻭ ﺭﺿﺎﻳﺖ 94 ﺩﺭﺻـﺪ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﺍﻳﻦ ﺭﻭﺵ ﺩﺭﻣﺎﻧﻲ ﻭ ﻧﻈـﺮ ﺑﺮ ﺍﻳﻨﮑﻪ ﺍﻳﻦ ﺭﻭﺵ ﻏﻴـﺮ ﺗﻬﺎﺟﻤﻲ ﻭ ﮐﻢ ﻫـﺰﻳﻨﻪ ﻣﻲ ﺑﺎﺷﺪ، ﺩﺭﻣـﺎﻥ ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ ﺩﺭ ﺑﻴﻤـﺎﺭﺍﻥ ﺑﺎ ﺩﺭﺟـﻪ 1، 2 ﻭ ﺩﺭ ﺑﻌﻀـﻲ ﻣـﻮﺍﺭﺩ ﺩﺭﺟﻪ 3 ﻫﻤـﻮﺭﻭﺋﻴﺪ ﺩﺍﺧﻠﻲ ﻳﮏ ﺭﻭﺵ ﺍﻧﺘﺨﺎﺑﻲ ﻣﻲ ﺑﺎﺷـﺪ ﻭ ﺍﻟﺒﺘﻪ ﺩﺭ ﻣـﻮﺍﺭﺩ ﺧﺎﺻﻲ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭﺟﻪ 4 ﻧﻴﺰ ﺗﻮﺻﻴﻪ ﻣﻲ ﺷـﻮﺩ ﻭ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﻣﻄﺎﻟﻌﺔ ﻣﺎ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻣﻄﺎﻟﻌﺎﺕ ﺩﻳﮕـﺮ ﻣـﺮﺍﮐﺰ ﺩﻧﻴﺎ، ﺗﻘـﺮﻳﺒﺎﹰ ﻳﮑﺴﺎﻥ ﻭ ﻗﺎﺑﻞ ﻗﺒﻮﻝ ﻣﻲ ﺑﺎﺷﺪ. ﻋﻠﻲ ﺍﻟـﺮﻏﻢ ﺑﻌﻀﻲﮔـﺰﺍﺭﺵ ﻫﺎ ﻣﺒﻨﻲ ﺑﺮ ﻋﻔﻮﻧﺖ ﻭ ﺳﭙﺴﻴﺲ ﺩﺭ ﺍﻳﻦ ﺭﻭﺵ، ﻣﺎ ﭼﻨﻴﻦ ﻋـﺎﺭﺿﻪ ﺍﻱ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺧـﻮﺩ ﻧﺪﻳﺪﻳﻢ.

Introduction & Objective: Rubber band ligation is one of outpatient treatments of internal hemorrhoid; it leads to ischemic necrosis of hemorrhoids. This method has been carried out prospectively in Hazrat-e-Rasoul hospital or office in which patients were that treated with rubber band ligation, and it was evaluated and compared with results of other centers. Materials & Methods: Our study populations were 50 patients with hemorrhoids who referred to the colorectal clinic of Hazrat-e-Rasool Hospital or private clinic between October 2003 to March 2005. The study considered the patients with hemorrhoids in grades 1, 2 and 3, for whom the most common symptom was bleeding. They were treated with Rubber Band ligation. We have used both disposable O’Regan and reusable McGiveny instrument. Results: In our study sample, 35 patients were in grade 2, 10 in grade 3 and 5 in grade 1 of internal hemorrhoids. A 6-months follow up considered for post operative evaluation. 36 of 50 patients had no postoperative pain (72%), 13 patients had mild or moderate pain (26%), and 1(2%) had severe pain. The patients were classified in three groups according to their response to the treatment: Group 1 had no change of severity and interval of symptoms, and therefore had no response. Group 2 had relative response to the treatment in view of severity and interval of symptoms. Group 3 had complete response to the treatment and their symptoms were disappeared and no recurrence in the follow-up was detected In patients treated with Rubber Band Ligation, 1 of 50 (2%) 2 of 50 (4%) and 47 of 50 (94%) had no response, relative response and complete response, respectively. Conclusions: Rubber Band ligation considered of outpatient procedure for the treatments of hemorrhoids. This method most use for grade 1, 2 and sometime grade 3 hemorrhoids. According to our study results, with 94% good or excellent response, we conclude that this technique is first choice for grade 1 to 3 internal hemorrhoids and occasionally it can be used for grade 4. In our series aside from some reports about sepsis in rubber band technique, we didn’t observe any cases of sepsis.