{"id":3738,"date":"2015-07-08T10:06:08","date_gmt":"2015-07-08T10:06:08","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/caso-clinico-ligadura-elastica-de-hemorroidas\/"},"modified":"2023-03-13T17:46:55","modified_gmt":"2023-03-13T17:46:55","slug":"caso-clinico-ligadura-elastica-de-hemorroidas","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-ligadura-elastica-de-hemorroidas\/","title":{"rendered":"Ligadura el\u00e1stica de hemorr\u00f3idas"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"3738\" class=\"elementor elementor-3738\">\n\t\t\t\t\t\t<section class=\"penci-section penci-disSticky penci-structure-10 elementor-section elementor-top-section elementor-element elementor-element-16d4f0f3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"16d4f0f3\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"penci-ercol-100 penci-ercol-order-1 penci-sticky-ct    elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-52925fd0\" data-id=\"52925fd0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-326fbf4 elementor-widget elementor-widget-text-editor\" data-id=\"326fbf4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tO tratamento cir\u00fargico \u00e9 o tratamento cl\u00e1ssico e mais difundido para a doen\u00e7a hemorroid\u00e1ria, por\u00e9m existem algumas alternativas como a hemorroidopexia com grampeamento, a identifica\u00e7\u00e3o do vaso hemorroid\u00e1rio por ultrassonografia seguida de ligadura com pontos e interrup\u00e7\u00e3o do fluxo sangu\u00edneo, e a ligadura el\u00e1stica do vaso hemorroid\u00e1rio.\n\nApresentamos aqui uma alternativa que tem sido cada vez mais difundida no meio endosc\u00f3pico: a \u00a0ligadura el\u00e1stica endosc\u00f3pica.\n\n&nbsp;\n\n<div style=\"position:relative;padding-top:56.33802816901409%;\"><iframe id=\"panda-b42577a3-0e00-4427-9e6f-b545592e71a7\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=b42577a3-0e00-4427-9e6f-b545592e71a7\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n&nbsp;\n\n&nbsp;\n<h2><strong>CASO CL\u00cdNICO<\/strong><\/h2>\nEste v\u00eddeo apresenta o tratamento de uma paciente de\u00a0 62 anos, sexo feminino, hipertensa controlada, com hist\u00f3ria de sangramento e prolapso hemorroid\u00e1rio h\u00e1 mais de 5 anos com piora no ultimo m\u00eas. \u00a0Refere que o prolapso hemorroid\u00e1rio \u00e9 redut\u00edvel com manobras manuais.\n\nAo exame f\u00edsico observa-se prolapso hemorroid\u00e1rio importante por\u00e9m redut\u00edvel, e com sinais de sangramento recente. Paciente recusa o tratamento cir\u00fargico!\n\nFoi indicado ent\u00e3o a realiza\u00e7\u00e3o de colonoscopia, j\u00e1 que a\u00a0 paciente nunca tinha sido submetida a uma anteriormente para preven\u00e7\u00e3o do c\u00e2ncer colorretal, e ao final do\u00a0exame programado a realiza\u00e7\u00e3o das ligaduras el\u00e1sticas. Neste caso, optou-se pela ligadura em toda a circunfer\u00eancia no intuito de realizar uma pexia do prolapso.\n\nA paciente evoluiu bem, com dor de moderada intensidade durante os primeiros 2 dias, que foi controlada com analg\u00e9sicos. Apresentou sangramento em pequena quantidade no s\u00e9timo ap\u00f3s o procedimento (per\u00edodo em que as bandas caem), e na avalia\u00e7\u00e3o ap\u00f3s 1 m\u00eas referiu n\u00e3o apresentar mais sangramento \u00e0s evacua\u00e7\u00f5es e nem prolapso. Ao exame, presen\u00e7a de alguns plicomas sem prolapso e sem sinais de sangramento. \u00c0 anuscopia, mant\u00e9m alguns vasos hemorroid\u00e1rios dilatados (hemorroidas grau I).\n<h2><b>DISCUSS\u00c3O<\/b><\/h2>\nO conceito \u00e9 realizar uma trombose hemorroid\u00e1ria acima da linha pect\u00ednea, \u00a0provocando a interrup\u00e7\u00e3o do fluxo sangu\u00edneo associada \u00e0\u00a0retra\u00e7\u00e3o do prolapso, melhorando assim o sangramento e a exterioriza\u00e7\u00e3o das hemorr\u00f3idas.\n\nA ligadura el\u00e1stica j\u00e1 \u00e9 conhecida e praticada em consult\u00f3rios h\u00e1 v\u00e1rios anos, mas \u00a0nem todos os profissionais conhecem a t\u00e9cnica, e existe a limita\u00e7\u00e3o de ser realizada com paciente consciente, e por\u00a0vezes com a dificuldade no posicionamento ideal do anusc\u00f3pio para\u00a0 a coloca\u00e7\u00e3o da banda el\u00e1stica.\n\nApesar do maior custo quando realizada endoscopicamente (utiliza\u00e7\u00e3o de aparelho, Kit de ligadura, seda\u00e7\u00e3o, etc), comparada \u00e0 realizada ambulatorialmente com o anusc\u00f3pio e um kit de ligadura mais simples, a maior facilidade no posicionamento das bandas acima da linha pect\u00ednea e a possibilidade de realizar v\u00e1rias ligaduras em um \u00fanico procedimento, na minha opini\u00e3o, fazem com que o m\u00e9todo endosc\u00f3pico seja o mais vantajoso.\n\nAl\u00e9m disso, quando realizadas v\u00e1rias ligaduras simultaneamente, e de forma circunferencial, a pexia do prolapso \u00e9 mais efetiva.\n\nDeve-se sempre examinar o paciente para decidir se este \u00e9 candidato ou n\u00e3o para realiza\u00e7\u00e3o da ligadura el\u00e1stica. As indica\u00e7\u00f5es para esse procedimento s\u00e3o sangramento e prolapso redut\u00edvel das hemorroidas (hemorroidas at\u00e9 grau III). Pacientes com trombose hemorroid\u00e1ria n\u00e3o se beneficiam do procedimento, podendo at\u00e9 apresentar piora do quadro.\n\nLembrando que o exame proctol\u00f3gico completo do paciente, com inspe\u00e7\u00e3o din\u00e2mica, externa e interna com uso de anuscopia, deve ser realizado para decis\u00e3o da melhor indica\u00e7\u00e3o para o tratamento. Este \u00e9 um conceito fundamental, a indica\u00e7\u00e3o n\u00e3o pode ser tomada apenas pelo aspecto endosc\u00f3pico.\n\nComparado com\u00a0 o tratamento cir\u00fargico, a ligadura el\u00e1stica tem a desvantagem de ser menos efetiva a longo prazo, devido ao maior \u00edndice de recidivas. Como vantagem, temos o menor desconforto, principalmente em rela\u00e7\u00e3o a dor, a possibilidade de realizar o procedimento apenas com seda\u00e7\u00e3o, a volta \u00e0s atividades num per\u00edodo curto de tempo, e caso o tratamento n\u00e3o seja efetivo, ele n\u00e3o impossibilita um eventual tratamento cir\u00fargico.\n\nA ligadura \u00e9 feita com um gastrosc\u00f3pio em retrovis\u00e3o e com um kit de ligadura de varizes esof\u00e1gicas. J\u00e1 existem kits de ligadura para colonosc\u00f3pios que tem calibre maior, o que pode ser mais efetivo, por\u00e9m, a retrovis\u00e3o e o posicionamento correto para a ligadura s\u00e3o mais f\u00e1ceis com o gastrosc\u00f3pio, que possui uma mobilidade maior.\n<h2><strong>Alguns cuidados devem ser tomados:<\/strong><\/h2>\n<ul>\n \t<li>A identifica\u00e7\u00e3o correta dos vasos hemorroid\u00e1rios que produzem os sintomas, para a aplica\u00e7\u00e3o das primeiras bandas. (import\u00e2ncia do exame proctol\u00f3gico).<\/li>\n \t<li>A ligadura deve ser acima e pr\u00f3ximo \u00e0 transi\u00e7\u00e3o entre mucosa e pele, mas deve-se evitar ao m\u00e1ximo a pega da linha pect\u00ednea, o que\u00a0pode provocar dor intensa.<\/li>\n \t<li>Caso haja prolapso hemorroid\u00e1rio, a aplica\u00e7\u00e3o de v\u00e1rias bandas circunferencialmente ajuda bastante no resultado final, sendo as primeiras bandas colocadas nos pontos principais escolhidos e as outras entre os mesmos, no intuito de causar uma retra\u00e7\u00e3o que puxe o prolapso para dentro.<\/li>\n<\/ul>\n<h2><strong>Orienta\u00e7\u00f5es ao paciente:<\/strong><\/h2>\nO paciente deve ser orientado que:\n<ul>\n \t<li>A efetividade deste tratamento \u00e9 menor do que o cir\u00fargico.<\/li>\n \t<li>Apesar de ser menos invasivo e com proposta de\u00a0causar menos dor, caso ocorra a inclus\u00e3o da linha pect\u00ednea em alguma ligadura, a dor pode ser intensa e com necessidade de analg\u00e9sicos.<\/li>\n \t<li>Ap\u00f3s o procedimento as ligaduras provocam a sensa\u00e7\u00e3o de ampola retal com conte\u00fado, o que leva \u00e0 sensa\u00e7\u00e3o de necessidade evacuat\u00f3ria cont\u00ednua num per\u00edodo de aproximadamente 3 dias.<\/li>\n \t<li>Podem ocorrer complica\u00e7\u00f5es como: dor, bacteremia, trombose hemorroid\u00e1ria externa, queda de alguma banda com posterior sangramento.<\/li>\n<\/ul>\n&nbsp;\n\n<a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/07\/Curriculo-Giulio.png\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-2015\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Curriculo-Giulio.png\" alt=\"Curriculo Giulio\" width=\"392\" height=\"153\" \/><\/a>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>O tratamento cir\u00fargico \u00e9 o tratamento cl\u00e1ssico e mais difundido para a doen\u00e7a hemorroid\u00e1ria,&hellip;<\/p>\n","protected":false},"author":2102,"featured_media":3739,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[282],"tipo":[156],"volume":[147],"class_list":["post-3738","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-282","tipo-colonoscopia","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Ligadura el\u00e1stica de hemorr\u00f3idas &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-ligadura-elastica-de-hemorroidas\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ligadura el\u00e1stica de hemorr\u00f3idas\" \/>\n<meta property=\"og:description\" content=\"O tratamento cir\u00fargico \u00e9 o tratamento cl\u00e1ssico e mais difundido para a doen\u00e7a hemorroid\u00e1ria, por\u00e9m existem algumas alternativas como a hemorroidopexia com\" \/>\n<meta property=\"og:url\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-ligadura-elastica-de-hemorroidas\/\" \/>\n<meta property=\"og:site_name\" content=\"Endoscopia Terapeutica\" \/>\n<meta property=\"article:publisher\" 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