透明帽辅助内镜下硬化术治疗痔疮的前瞻性研究（含视频）

Cap-assisted endoscopic sclerotherapy for hemorrhoids： a prospective study （with video）

目的评估透明帽辅助内镜下硬化术（CAES）治疗痔疮的方法学、可行性、安全性和有效性。方法对2014年9月至2016年5月收治的Ⅰ-Ⅲ度内痔患者行CAES治疗。依据CAES设计的内容，同步鉴别便血原因，并对检查过程中所发现的可切除息肉、肛乳头纤维瘤予以同步治疗。前瞻性观察CAES治疗痔疮的疗效，术中、术后并发症及患者满意度，随访时间超过3个月。结果共48例Ⅰ-Ⅲ度内痔患者接受CAES治疗，其中Ⅰ度25例（52．1％）、Ⅱ度21例（43．8％）、Ⅲ度2例（4．2％）。实施CAES同时一并完成的操作包括回结肠检查48例（100．0％），内镜下息肉切除术14例（29．2％），内镜下肛乳头纤维瘤切除术1例（2．1％），内镜下外痔切除术1例（2．1％），齿状线区域息肉的活检或切除2例（4．2％），黏膜脱垂硬化术2例（4．2％）。CAES术中、术后均无患者出现出血。1例（2．1％）患者术后出现感染，抗感染治疗1周后痊愈。1例（2．1％）患者在CAES术后4d诉轻度里急后重感。术后随访3个月，无患者出现并发症。患者对CAES的满意度为100．O％（48／48）。结论CAES作为一种治疗痔疮的新型内镜下硬化疗法，安全、有效、操作简便、患者满意度高。

Objective To evaluate the methodology, feasibility, safety and efficacy of cap-assisted endoscopic sclerotherapy （CAES） for hemorrhoids. Methods Patients with grade Ⅰ to Ⅲinternal hemorrhoids underwent CAES from September 2014 to May 2016. According to the methodology of CAES, reasons for blooding were identified and polypectomy and excision of anal papilla fibroma was performed. Efficacy, intraoperative and postoperative complications and patient satisfaction were evaluated during and after CAES. The follow-up was more than three months. Results A total of 48 patients with grade Ⅰ to Ⅲ internal hemorrhoids underwent CAES, including 25 （52. 1%） patients with grade Ⅰ , 21 （43.8%） patients with grade Ⅱ , and 2 （ 4. 2%） grade Ⅲ. During the whale procedure of CAES, colon and terminal ileum examination was performed in 48（ 100. 0%） patients, polypectomy was performed in 14（29. 2%） patients, excision of anal papilla fibroma was performed in 1 （2. 1%） patient, excision of external hemorrhoids was performed in 1 （2. 1%） patient, biopsy for the polyps on dentate line was performed in 2 （4. 2%） patients, and sclerotherapy for rectal mucosal prolapse was performed in 2（4. 2% ） patients. No bleeding was observed during and after CAES. Infection occurred in one （2. 1%） patient, who recovered with a one-week anti- infective therapy. One （2. 1%） patient claimed mild tenesmus within four days after CAES. No complications were observed within the three-month follow-up. All patients （100. 0%） were satisfied with this novel procedure. Conclusion CAES, as a novel endoscopic sclerotherapy, is a safe and effective endoscopic therapy with high patient satisfaction for internal hemorrhoids.