内痔内镜下微创治疗疗效及复发率的单中心大样本回顾性观察  

Single-center large sample retrospective observation of the efficacy and recurrence rate of minimally invasive endoscopic treatment for internal hemorrhoids

作　　者：朱颖 夏瑰丽 程庆 李来贺 许雯 Zhu Ying;Xia Guili;Cheng Qing;Li Laihe;Xu Wen(Department of Gastroenterology,Shenzhen Hospital of Southern Medical University,Shenzhen 518100,China)

机构地区：[1]南方医科大学深圳医院消化内科,深圳518100

出　　处：《中华消化内镜杂志》2024年第4期304-309,共6页Chinese Journal of Digestive Endoscopy

基　　金：广东省医学科学技术研究基金项目(B2022201);广东省卫生健康适宜推广项目(20216252151077306)。

摘　　要：目的:评估内痔内镜下微创治疗的临床价值。方法:2018年12月至2022年6月,南方医科大学深圳医院内镜中心行内镜下微创治疗的1027例Ⅰ~Ⅲ度内痔病例纳入回顾性分析,其中接受内镜下硬化剂注射治疗者552例、接受内镜下套扎治疗者404例、接受内镜下套扎联合硬化剂注射治疗者71例,主要观察总体以及不同治疗方法下的治疗有效率和复发率。结果:内镜下内痔微创治疗总体有效率为94.5%(971/1027):内镜下硬化剂注射治疗552例,其中Ⅰ度、Ⅱ度和Ⅲ度内痔分别为251例(45.5%)、259例(46.9%)和42例(7.6%),总体治疗有效率为92.9%(513/552),其中Ⅰ度、Ⅱ度和Ⅲ度内痔的治疗有效率分别为94.4%(237/251)、91.9%(238/259)和90.5%(38/42);内镜下套扎治疗404例,其中Ⅰ度、Ⅱ度和Ⅲ度内痔分别为21例(5.2%)、194例(48.0%)和189例(46.8%),总体治疗有效率为96.0%(388/404),其中Ⅰ度、Ⅱ度和Ⅲ度内痔的治疗有效率分别为100.0%(21/21)、98.5%(191/194)和93.1%(176/189);内镜下套扎联合硬化剂注射治疗71例,其中Ⅰ度、Ⅱ度和Ⅲ度内痔分别为0例(0.0%)、13例(18.3%)和58例(81.7%),总体治疗有效率为98.6%(70/71),其中Ⅱ度和Ⅲ度内痔的治疗有效率分别为100.0%(13/13)和98.3%(57/58)。首次内镜下治疗后随访3~43个月,内镜下内痔微创治疗总体复发率为11.2%(109/971):513例内镜下硬化剂注射治疗有效者中,74例(14.4%)复发,其中Ⅰ度、Ⅱ度和Ⅲ度内痔的复发率分别为4.6%(11/237)、21.4%(51/238)和31.6%(12/38);388例内镜下套扎治疗有效者中,29例(7.5%)复发,其中Ⅰ度、Ⅱ度和Ⅲ度内痔的复发率分别为0.0%(0/21)、5.8%(11/191)和10.2%(18/176);70例内镜下套扎联合硬化剂注射治疗有效者中,6例(8.6%)复发,其中Ⅱ度和Ⅲ度内痔的复发率分别为7.7%(1/13)和8.8%(5/57)。结论:内痔行内镜下微创治疗总体疗效好、复发率低,具有较好的临床应用价值。对于Ⅰ度内痔,选择内镜下硬化剂注射治疗即�Objective To investigate the clinical value of minimally invasive endoscopic treatment for internal hemorrhoids.Methods A total of 1027 cases of gradeⅠtoⅢinternal hemorrhoids who underwent minimally invasive endoscopic treatment in the Endoscopy Center of Shenzhen Hospital of Southern Medical University From December 2018 to June 2022 were included in the retrospective analysis,including 552 cases of endoscopic sclerotherapy,404 of endoscopic ligation,and 71 of endoscopic ligation combined with sclerotherapy.The effective rate and recurrence rate were observed in general and different treatment methods.Results The overall effective rate of minimally invasive treatment of internal hemorrhoids under endoscopy was 94.5%(971/1027).Among the 552 cases treated with endoscopic sclerotherapy,251 cases(45.5%)were gradeⅠ,259(46.9%)gradeⅡand 42(7.6%)gradeⅢ.The overall effective rate was 92.9%(513/552),and the effective rates of gradeⅠ,ⅡandⅢhemorrhoids were 94.4%(237/251),91.9%(238/259)and 90.5%(38/42),respectively.For 404 cases of endoscopic ligation,there were 21 cases(5.2%),194 cases(48.0%)and 189 cases(46.8%)of internal hemorrhoids in gradeⅠ,ⅡandⅢ,respectively.The overall treatment effective rate was 96.0%(388/404),and the effective rates of grade I,ⅡandⅢhemorrhoids were 100.0%(21/21),98.5%(191/194)and 93.1%(176/189),respectively.Fore 71 cases treated with endoscopic ligation combined with sclerosing agent injection,there were 0 cases(0.0%),13 cases(18.3%)and 58 cases(81.7%)of internal hemorrhoids in gradeⅠ,ⅡandⅢ,respectively.The overall treatment effective rate was 98.6%(70/71).The effective rates of gradeⅡandⅢhemorrhoids were 100.0%(13/13)and 98.3%(57/58),respectively.The overall recurrence rate of minimally invasive treatment for internal hemorrhoids under endoscopy was 11.2%(109/971)at a follow-up of 3 to 43 months after the first endoscopic treatment.Among 513 patients who were effectively treated with endoscopic sclerotherapy,74(14.4%)recurred,and the recurrence rates of gradeⅠ

关 键 词：内痔 内镜下微创治疗 疗效 复发率 

分 类 号：R657.18[医药卫生—外科学]