【摘要】 目的比较CO2激光和Nd∶YAG激光治疗外痔的疗效。方法226例外痔住院患者随机分为CO2激光组126例和Nd∶YAG激光手术组100例。两组激光的治疗参数相同:输出功率30 W、光斑直径0.2 cm、功率密度955 W/cm2。以激光在两钳间切除痔核,基底部凝固止血,一并气化或切除并发的肛裂或直肠息肉,创面填塞包扎不需缝合。术后保持大便通畅,口服抗生素7 d。术后3 d行半导体激光照射创面,功率100 mW,光斑直径3 cm,功率密度14 mW/cm2,每创面照射8 min,每日1次,共照射5 d。结果1次治愈率CO2激光组为94.4%,Nd∶YAG激光组为90.0%(P>0.05)。激光手术平均时间、术后肛门疼痛平均时间、术后创面炎性反应消失、结痂和治愈平均天数CO2激光组均短于Nd∶YAG激光组(P<0.05或0.01),而术中平均出血量Nd∶YAG激光组明显少于CO2激光组(P<0.05)。结论CO2激光和Nd∶YAG激光在同等治疗参数下,治疗外痔均有较好的治疗效果。但CO2激光有较好的切割能力,对组织损伤小,可用于单纯外痔痔核切除术;而Nd∶YAG激光有较好的凝固止血作用,可用于静脉曲张性外痔凝固术或痔核切除后创面出血凝固止血。更多还原

【Abstract】 Objective To contrast and observe the effect of operative treatment in patients with external hemorrhoids by 10.6 μm far infrared wavelength CO2 laser and 1.06 μm near infrared wavelength Nd ∶YAG laser.Methods In 226 patients with external hemorrhoids were randomly divided into two groups: CO2 laser group(126 patients) and Nd ∶YAG laser group(100 patients).The dosage of laser was the same in the two groups such as power was 30 W,diameter of light spot 0.2 cm and density of power 955 W/cm2.The external hemorrhoids were excised between two pliers,then remnant end was solidified by laser irradiation for stopping bleeding.Focuses were excised in the same time if patients with anal fissure or proctopolypus complication.All wounds neededn’t be sutured,only needed stopping up and binding up after operation.Kept feces looseness after operation,1 ∶5 000 potassium permanganate sitting bath after stool ejection,and oral antibiotic for 7 d.The wounds were irradiated by semiconductor laser 3 days after operation for 5 d(power 100 mW,diameter of light spot 3 cm and density of power 14 mW/cm2),irradiation 8 minutes per light spot and once per diem.Results All patients were cure in the two groups.One-time postoperative cure rate was 94.4% in the CO2 laser group and 90.0% in the Nd ∶YAG laser group(P>0.05).The therapeutic effect showed that operative average time,anus painful average time,average number of days of inflammatory reaction,scab and cure after operation in the CO2 laser group were shorter than that of in the Nd ∶YAG laser group(P<0.05 or 0.01).The average quantity of bleeding in the operation in the Nd ∶YAG laser group was less than that in the CO2 laser group(P<0.05).Conclusions The results indicate that for all patients with external hemorrhoids therapeutic effect is better by 10.6 μm far infrared wavelength CO2 laser and 1.06 μm near infrared wavelength Nd ∶YAG laser on condition of the same dosage.But the CO2 laser cutting ability is better and the damage of tissue is less,it can be used to resect simple external hemorrhoids.The Nd ∶YAG laser effect on hemorrhage stopping is better,it can be used to solidify variceal external hemorrhoids and hemostasis of wounds in the operation.更多还原