内镜下套扎与硬化剂注射治疗内痔有效性及安全性的回顾性队列研究  

A retrospective cohort study of the efficacy and safety of endoscopic ligation versus injection sclerotherapy for internal hemorrhoids

作　　者：高莉[1] 杨位轩 田莉 巩尧瑶[1] 程文芳[1] Gao Li;Yang Weixuan;Tian Li;Gong Yaoyao;Cheng Wenfang(Department of Gastroenterology,The First Affiliated Hospital with Nanjing Medical University,Nanjing210029,China;Department of Gastroenterology,The Fifth People's Hospital of Huai'an,Huai'an223300,China;Department of Gastroenterology,Zigong Fourth People's Hospital,Zigong643000,China)

机构地区：[1]南京医科大学第一附属医院消化内科,南京210029 [2]淮安市第五人民医院消化内科,淮安223300 [3]自贡市第四人民医院消化内科,自贡643000

出　　处：《中华消化内镜杂志》2024年第12期973-978,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的:评估内镜下套扎与硬化剂注射治疗内痔的有效性及安全性。方法:2020年4月至2023年10月间,因Ⅰ~Ⅲ度内痔在南京医科大学第一附属医院(江苏省人民医院)行内镜下套扎或硬化剂注射治疗的106例连续病例纳入回顾性队列研究,按内镜治疗方式分成套扎组( n=70)和硬化剂注射组( n=36),主要观察2组间治疗有效率、住院时间、术后疼痛、不良事件发生率、患者满意度及复发率差异。 结果:套扎组治疗有效率为95.7%(67/70),硬化剂注射组为100.0%(36/36),组间差异无统计学意义( P=0.549)。套扎组住院时间6.0(4.0,7.3)d,硬化剂注射组为3.0(2.0,4.0)d,组间差异有统计学意义( Z=4.305, P<0.001)。套扎组术后24 h疼痛发生率为58.6%(41/70),硬化剂注射组为11.1%(4/36),组间差异有统计学意义( χ^(2)=20.020, P<0.001)。2组术后均无肛门狭窄、血栓性外痔等严重不良事件发生,仅肛门坠胀发生率组间差异有统计学意义[套扎组比硬化剂注射组:38.6%(27/70)比5.6%(2/36), χ^(2)=11.431, P<0.001]。套扎组患者满意度为87.1%(61/70),硬化剂注射组为86.1%(31/36),组间差异无统计学意义( P=1.000)。套扎组和硬化剂注射组分别有1例和15例失访,复发率分别为14.5%(10/69)和33.3%(7/21),组间差异无统计学意义( P=0.064)。Ⅰ~Ⅱ度内痔的亚组分析:套扎组和硬化剂注射组Ⅰ~Ⅱ度内痔分别有43例和29例。治疗有效率、术后出血发生率、排尿困难发生率、患者满意度组间差异均无统计学意义( P>0.05);套扎组术后疼痛、肛门坠胀发生率均明显高于硬化剂注射组[术后疼痛发生率:65.1%(28/43)比10.3%(3/29), χ^(2)=19.016, P<0.001;术后肛门坠胀发生率:41.9%(18/43)比3.4%(1/29), χ^(2)=11.252, P<0.001];套扎组和硬化剂注射组分别有43例和17例完成随访,复发率分别为11.6%(5/43)和23.5%(4/17),复发率组间差异无统计学意义( P=0.256)。Ⅲ度内痔的亚组分析:套扎组和硬化剂注射组Ⅲ度内痔�ObjectiveTo investigate the efficacy and safety of endoscopic ligation and injection sclerotherapy for internal hemorrhoids.MethodsFrom April 2020 to October 2023,106 patients with gradeⅠtoⅢinternal hemorrhoids who underwent endoscopic ligation or injection sclerotherapy in the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province People's Hospital)were consecutively enrolled in the retrospective cohort study.Patients were divided into the ligation group(n=70)and the injection sclerotherapy group(n=36)according to the endoscopic treatment methods.The effective rate,hospital stay,postoperative pain,the incidence of complications,patient satisfaction and the recurrence rate of the two groups were assessed.ResultsThe effective rate was 95.7%(67/70)and 100.0%(36/36)respectively in the ligation group and the injection sclerotherapy group without significant difference(P=0.549).The hospital stay was 6.0(4.0,7.3)days and 3.0(2.0,4.0)days respectively in the ligation group and the injection sclerotherapy group with significant difference(Z=4.305,P<0.001).The incidence of 24-hour postoperative pain was 58.6%(41/70)and 11.1%(4/36)in the two groups respectively and the difference was statistically significant(χ^(2)=20.020,P<0.001).There were no serious postoperative adverse events such as anal stenosis or thrombotic external hemorrhoids in the two groups.Only the incidence of anal distension was significantly different between the ligation group and the injection sclerotherapy group[38.6%(27/70)VS 5.6%(2/36),χ^(2)=11.431,P<0.001].The patient satisfaction rate of the two groups showed no significant difference[87.1%(61/70)VS 86.1%(31/36),P=1.000].There was 1 patient and 15 patients lost to follow-up respectively in the ligation group and the injection sclerotherapy group,and the recurrence rate of the two groups showed no significant difference[14.5%(10/69)VS 33.3%(7/21),P=0.064].Subgroup analysis of gradeⅠ-Ⅱinternal hemorrhoids:there were 43 patients and 29 patients in the ligation group and t

关 键 词：痔 内痔 硬化 套扎 疗效 并发症 

分 类 号：R65[医药卫生—外科学]