肠镜下泡沫硬化剂治疗出血性内痔的疗效评估  

Therapeutic effects of endoscopic foam sclerotherapy for bleeding internal hemorrhoids

作　　者：沈峰[1] 瞿春莹[1] 张毅[1] 周敏[1] 邓振忠 朱华丽 朱京阳 陈光榆[4] 张熙 徐雷鸣[1] Shen Feng;Qu Chunying;Zhang Yi;Zhou Min;Deng Zhenzhong;Zhu Huali;Zhu Jingyang;Chen Guangyu;Zhang Xi;Xu Leiming(Department of Gastroenterology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Gastroenterology,Jiaxing Second Hospital,Jiaxing 314000,China;Department of Gastroenterology,Minhang Traditional Chinese Medicine Hospital,Shanghai 201103,China;Clinical Research Unit,XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院消化内科内镜诊治部,200092 [2]嘉兴市第二医院消化内科,314000 [3]上海市闵行区中医医院消化内科,201103 [4]上海交通大学医学院附属新华医院临床研究中心,200092

出　　处：《中华消化内镜杂志》2019年第12期917-922,共6页Chinese Journal of Digestive Endoscopy

基　　金：上海交通大学“交大之星”计划医工交叉研究基金(YG2019QNB32);上海交通大学医学院附属新华医院院级临床研究创新项目(19XHCR16D)。

摘　　要：目的评价肠镜下泡沫硬化剂注射治疗出血性内痔的安全性及有效性。方法前瞻性纳入2017年3月至2018年3月连续就诊的Ⅰ期出血性内痔成年(18~60岁)患者,随机数字表法分为泡沫硬化剂组(FS)和液体硬化剂组(LS)。透明帽辅助肠镜下行痔核内泡沫硬化剂或液体硬化剂注射治疗。结果共纳入患者108例,年龄(44.0±7.6)岁,男性62例(57.4%)。FS组55例,LS组53例,2组在性别、年龄、体重指数等方面差异无统计学意义。FS组聚桂醇注射液总量为(3.7±0.9)mL,显著低于LS的(8.0±2.2)mL(P<0.001)。在LS组,8例(15.1%)出现拔针后渗血,借助透明帽压迫止血,显著高于FS组3例(5.5%)(P=0.022)。LS组术后显著疼痛2例(3.8%),FS组为0例,差异有统计学意义(P=0.025)。FS组短期治愈率87.3%(48/55),显效9.1%(5/55),LS组分别为69.8%(37/53)及22.6%(12/53),组间差异有统计学意义(P=0.046)。结论泡沫硬化剂注射治疗出血性内痔安全有效,副作用少,治愈率高,值得临床推广。Objective To evaluate the safety and efficacy of foam sclerotherapy for bleeding internal hemorrhoids.Methods Consecutive adult patients(aged 18-60 years)with bleeding hemorrhoids were prospectively enrolled between March 2017 and March 2018.All patients were randomly assigned to the foam sclerotherapy(FS)group and the liquid sclerotherapy(LS)group.The foam and liquid sclerotherapy of hemorrhoids nucleus was performed by cap-assisted colonic endoscopy.Results A total of 108 patients were enrolled,including 62 males(57.4%)with mean age of 44.0±7.6 years.There was no significant difference in gender,age,or body mass index between the FS(n=55)group and the LS(n=53)group.The total amount of lauromacrogol injection in the FS group was 3.7±0.9 mL,which was significantly lower than that in the LS group(8.0±2.2 mL,P<0.001).In the LS group,8 patients(15.1%)developed bleeding after needle removal,which was significantly higher than that in the FS group[5.5%(3/53),P=0.022].Significant pain was found in 2 patients(3.8%)in the LS group and 0 in the FS group(P=0.025).The short-term cure rate and effective rate of the FS group were 87.3%(48/55)and 9.1%(5/55),while those were 69.8%(37/53)and 22.6%(12/53)in the LS group,respectively(P=0.046).Conclusion Foam sclerotherapy is safe and effective in the treatment of bleeding internal hemorrhoids.

关 键 词：痔 硬化溶液 止血 内窥镜 硬化剂治疗 

分 类 号：R657[医药卫生—外科学]