硬化剂联合内镜套扎术治疗Ⅲ、Ⅳ期内痔的临床效果及复发影响因素分析  

Clinical efficacy of sclerosing agent combined with endoscopic band ligation for grade Ⅲ and Ⅳ internal hemorrhoids and analysis of factors influencing postoperative recurrence

作　　者：曹信宇 刘青[2] 孟凡涛 王玲[3] 商伟芳 CAO Xinyu;LIU Qing;MENG Fantao;WANG Ling;SHANG Weifang(Department of Endoscopy,Peking University Third Hospital Qinhuangdao Hospital,Qinhuangdao 066000,Hebei,China;Department of Urology,Peking University Third Hospital Qinhuangdao Hospital,Qinhuangdao 066000,Hebei,China;Department of Gastroenterology,Peking University Third Hospital Qinhuangdao Hospital,Qinhuangdao 066000,Hebei,China)

机构地区：[1]北京大学第三医院秦皇岛医院内窥镜诊疗科,河北秦皇岛066000 [2]北京大学第三医院秦皇岛医院1尿外科,河北秦皇岛066000 [3]北京大学第三医院秦皇岛医院消化内科,河北秦皇岛066000

出　　处：《中南医学科学杂志》2025年第2期349-352,共4页Medical Science Journal of Central South China

基　　金：秦皇岛市科学技术研究与发展计划项目(202301A252)。

摘　　要：目的观察硬化剂联合内镜套扎术治疗Ⅲ、Ⅳ期内痔的临床效果,并分析内痔患者术后复发风险的影响因素。方法选取500例Ⅲ、Ⅳ期内痔患者,随机分为对照组和观察组。观察组采用硬化剂联合内镜套扎术治疗,对照组采用单纯内镜套扎术治疗。比较两组手术时间、愈合时间、术中出血量、术后视觉模拟评分法(VAS)评分、复发情况和临床疗效。观察组患者根据术后是否复发分为复发组和未复发组,并进行两组的临床资料比较。采用Logistic回归分析术后复发的影响因素。结果观察组手术时间和愈合时间均短于对照组,术中出血量和术后VAS评分均低于对照组(P<0.05)。观察组复发率低于对照组,总有效率高于对照组(P<0.05)。复发组病程长于未复发组;年龄、Ⅳ期占比、辛辣饮食习惯、久坐、术后早排便占比均高于非复发组(P<0.05)。Logistic回归分析显示,病程、病情严重程度、饮食习惯、久坐是术后复发的影响因素(OR>1,P<0.05)。结论硬化剂联合内镜套扎术治疗Ⅲ、Ⅳ期内痔疗效显著,病程较长、Ⅳ期患者及久坐是术后复发的危险因素。Aim To investigate the clinical efficacy of sclerosing agent combined with endoscopic band ligation for grade Ⅲ and Ⅳ internal hemorrhoids and to analyze the influencing factors of postoperative recurrence risk.Methods A total of 500 patients with grade Ⅲ and Ⅳ internal hemorrhoids were randomly divided into a control group and an observation group.The observation group received sclerosing agent combined with endoscopic band ligation,while the control group received endoscopic band ligation alone.Surgical time,healing time,intraoperative bleeding,postoperative visual analogue scale(VAS) score,recurrence rate,and clinical efficacy were compared between the two groups.Patients in the observation group were divided into a recurrence group and a non recurrence group based on whether they experienced postoperative recurrence,and clinical data were compared between the two groups.Using Logistic regression analysis to identify the influencing factors of postoperative recurrence.Results The observation group had shorter surgical and healing times,less intraoperative bleeding,and lower postoperative VAS scores compared with the control group(P<0.05).The recurrence rate was lower,and the total efficacy was higher in the observation group(P<0.05).The recurrence subgroup had higher age,longer disease course,higher proportion of grade Ⅳ,spicy diet,sedentary behavior,and early postoperative defecation compared with the non-recurrence group(P<0.05).Logistic regression analysis showed that disease course,severity,diet,and sedentary behavior were independent risk factors for recurrence(OR>1,P<0.05).Conclusion Sclerosing agent combined with EBL is effective for grade Ⅲ and Ⅳ internal hemorrhoids.Longer disease course,grade Ⅳ,and sedentary behavior are risk factors for postoperative recurrence.

关 键 词：硬化剂联合内镜套扎术 Ⅲ、Ⅳ期内痔 临床效果 术后复发 影响因素 

分 类 号：R657.18[医药卫生—外科学]