内镜下胶圈套扎联合泡沫硬化剂注射术治疗Ⅱ~Ⅲ度混合痔内痔部分的临床研究

殷开红; 程银梦; 张韬; 柯希权; 徐峰; 赵昌东

doi:10.16766/j.cnki.issn.1674-4152.003282

内镜下胶圈套扎联合泡沫硬化剂注射术治疗Ⅱ~Ⅲ度混合痔内痔部分的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003282

殷开红¹,
程银梦¹,
张韬¹,
柯希权²,
徐峰^{1, 3},
赵昌东^{1, 3, ,}

1.
蚌埠医学院连云港临床学院，江苏连云港 222000
2.
蚌埠医学院第一附属医院消化内科，安徽蚌埠 233004
3.
连云港市第二人民医院消化内科, 江苏连云港 222000

基金项目:

安徽省教育厅2018年度高校优秀青年骨干人才国内外访学研修项目 gxgwfx2018052

江苏大学临床医学科技发展基金项目 JLY20180156

连云港市卫生健康面上科技项目 202223

详细信息

通讯作者:
赵昌东，E-mail：zcdzcd-2006@163.com

中图分类号: R657.18
计量
- 文章访问数: 67
- HTML全文浏览量: 18
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-04
- 网络出版日期: 2024-01-29

Clinical study of endoscopic rubber ring ligation combined with foam sclerosing agent injection in the treatment of internal hemorrhoids of grade Ⅱ to Ⅲ mixed hemorrhoids

1.
Bengbu Medical College Lianyungang clinical college, Lianyungang, Jiangsu 222000, China

摘要

摘要: 目的探讨内镜下胶圈套扎术(ERBL)联合泡沫硬化剂注射术(FS)治疗Ⅱ~Ⅲ度混合痔内痔部分的临床疗效及安全性。方法回顾性纳入2020年9月—2022年5月连云港市第二人民医院消化内科、胃肠外科行混合痔治疗的患者62例，根据手术方式不同，将接受ERBL联合FS的30例患者纳入治疗组，将仅接受传统外科外剥内扎术的32例患者纳入对照组。比较2组患者手术时间、住院时间、住院费用、术后并发症和临床疗效。随访6个月，评价其临床效果与安全性。结果 2组患者均顺利完成手术。治疗组手术时间、住院时间、住院费用均少于对照组，差异有统计学意义(均P＜0.05)。术后6个月，治疗组患者术后尿潴留、肛周红肿、肛门坠胀、排便困难均低于对照组(均P＜0.05)。治疗组术后24 h VAS评分低于对照组(U=252.000，P＜0.001)。术后1周出血情况治疗组低于对照组(U=192.500，P＜0.001)。术后6个月，治疗组治愈25例，有效4例，无效或复发1例，对照组治愈19例，有效7例，无效或复发6例，2组疗效比较差异有统计学意义(U=355.500，P=0.028)。结论 ERBL联合FS治疗Ⅱ~Ⅲ度混合痔的内痔部分安全有效，并发症少，治愈率高，值得临床推广。
- 混合痔 /
- 内镜 /
- 胶圈套扎术 /
- 泡沫硬化剂注射术
Abstract: Objective Exploring the clinical efficacy and safety analysis of endoscopic rubber band ligation (ERBL) combined with foam sclerotherapy (FS) in the treatment of mixed hemorrhoids of grade Ⅱ to Ⅲ. Methods A total of 62 patients who underwent mixed hemorrhoid treatment at the Department of Gastroenterology and Gastrointestinal Surgery of Lianyungang Second People's Hospital from September 2020 to May 2022 were retrospectively included. According to different surgical methods, 30 patients who received ERBL combined with FS were included in the treatment group. Thirty-two patients who only underwent traditional surgical external stripping and internal ligation were included in the control group. The operation time, hospitalization time, hospitalization expenses, postoperative complications and clinical efficacy were compared between the two groups of patients. Follow-up for 6 months was conducted to evaluate the clinical effect and safety. Results Both groups of patients successfully completed the surgery. The operation time, hospitalization time, and hospitalization expenses in the treatment group were all less than those in the control group, and the differences were statistically significant (all P < 0.05). Six months after surgery, postoperative urinary retention, perianal redness and swelling, anal swelling, and defecation difficulty in the treatment group were all lower than those in the control group (all P < 0.05). The VAS score 24 hours after surgery in the treatment group was lower than that in the control group (U=252.000, P < 0.001). The bleeding situation in the treatment group 1 week after surgery was lower than that in the control group (U=192.500, P < 0.001). Six months after surgery, 25 cases were cured in the treatment group, 4 cases were effective, and 1 case was ineffective or relapsed. In the control group, 19 cases were cured, 7 cases were effective, and 6 cases were ineffective or relapsed. The difference in efficacy between the two groups was statistically significant (U=355.500, P=0.028). Conclusion The combination of ERBL and FS is safe and effective in the treatment of internal hemorrhoids in grade Ⅱ to Ⅲ mixed hemorrhoids, with fewer complications and a high cure rate, and is worthy of clinical promotion.
- Mixed hemorrhoids /
- Endoscopy /
- Rubber ring ligation /
- Injection of foam hardener

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图 1 混合痔术前内镜下表现

注：A示倒镜观察见内痔核肿大，红色征明显处；B示术前可见内痔伴脱垂，需手法回纳。

Figure 1. Preoperative endoscopic findings of mixed hemorrhoids

下载: 全尺寸图片幻灯片

图 2 治疗组内镜下治疗过程

注：A、B示倒镜下对痔上黏膜行负压吸引后套扎治疗；C示内镜下胶圈套扎术后行泡沫硬化剂注射治疗；D示泡沫硬化剂分点痔核黏膜下注射，见白色泡沫显著隆起。

Figure 2. The process of endoscopic treatment in the intervention group

下载: 全尺寸图片幻灯片

图 3 治疗组术后6个月随访复查

注: A示镜下可见瘢痕形成(黑色箭头处)；B示术后6个月复查，见混合痔内痔部分脱垂回纳。

下载: 全尺寸图片幻灯片

表 1 2组混合痔患者手术相关指标比较[M(P₂₅, P₇₅)]

Table 1. Comparative analysis of surgical-related indexes in mixed hemorrhoids patients between two groups[M(P₂₅, P₇₅)]

组别	例数	手术时间(min)	术后住院时间(d)	住院费用(元)
治疗组	30	14.00(12.75, 15.00)	3.00(2.00, 3.00)	4 468.50(4 028.75, 4 975.25)
对照组	32	45.50(40.75, 52.50)	8.00(7.00, 9.00)	9 692.00(8 208.00, 10 557.50)
Z值		-6.782	-6.842	-6.719
P值		＜0.001	＜0.001	＜0.001

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表 2 2组混合痔患者术后24 h VAS评分、术后1周出血评分比较[例(%)]

Table 2. Comparative analysis of 24-hour postoperative VAS scores and bleeding scores in mixed hemorrhoids patients between two groups[cases(%)]

组别	例数	术后24 h VAS评分				术后1周出血
组别	例数	无(0分)	轻度(1~3分)	中度(4~6分)	重度(7~10分)	无	轻度	中度	重度
治疗组	30	26(86.67)	4(13.33)	0	0	25(83.33)	5(16.67)	0	0
对照组	32	14(43.75)	7(21.88)	2(6.25)	9(28.13)	9(28.13)	14(43.75)	6(18.75)	3(9.38)
U值		252.000				192.500
P值		＜0.001				＜0.001

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表 3 2组混合痔患者术后其他并发症情况比较[例(%)]

Table 3. Comparative analysis of postoperative complications in mixed hemorrhoids patients between two groups[cases(%)]

组别	例数	肛周红肿	肛门坠胀	排便困难	尿潴留
治疗组	30	2(6.67)	5(16.67)	3(10.00)	1(3.33)
对照组	32	12(37.50)	13(40.63)	10(31.25)	9(28.13)
χ²值		8.420	4.314	4.219	5.322
P值		0.040	0.038	0.040	0.021

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表 4 2组混合痔患者术后6个月疗效比较[例(%)]

Table 4. Comparative analysis of therapeutic effects at 6 months postoperatively in mixed hemorrhoids patients between two groups [cases(%)]

组别	例数	治愈	有效	无效或复发
治疗组	30	25(83.33)	4(13.33)	1(3.33)
对照组	32	19(59.38)	7(21.88)	6(18.75)
注：2组疗效比较，U=355.500，P=0.028。

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