不同内镜治疗策略对Ⅰ~Ⅲ度内痔疗效的单中心回顾性研究

Therapeutic effects of different endoscopic strategies on gradeⅠⅢinternal hemorrhoids:a single-center retrospective study

目的探讨不同内镜治疗策略对Ⅰ~Ⅲ度内痔的疗效及安全性。方法回顾性分析2018年12月—2020年12月因内痔于武汉大学人民医院行内镜下硬化术或套扎术治疗的107例患者临床资料,并随访其术后不良事件、有效率、满意度。结果107例患者中Ⅰ度内痔45例(42.06%),Ⅱ度56例(52.34%),Ⅲ度6例(5.60%)。在完成内痔内镜下治疗的同时,94.39%(101/107)患者同期完成其他消化道疾病内镜治疗。术后随访3~25个月,中位随访时间5个月。84例患者采用硬化剂原液治疗,术后不良事件8例,总有效率97.61%(82/84),满意率95.24%(80/84)。9例采用泡沫硬化剂治疗,术后未观察到不良事件,总有效率及满意率均为100.00%(9/9)。11例采用套扎治疗,术后不良事件2例,总有效率81.82%(9/11),满意率72.73%(8/11)。3例行硬化+套扎联合治疗,术后不良事件2例,总有效率100.00%(3/3),满意率66.67%(2/3)。硬化术手术耗费总体低于套扎术。进一步对Ⅰ、Ⅱ度内痔的亚组分析显示,对于Ⅰ度内痔患者,硬化术术后疼痛发生率低于套扎术(P<0.05);对于Ⅱ度内痔患者,两种术式不良事件、有效率及术后满意度方面差异无统计学意义(P>0.05)。结论内镜下硬化术及套扎术治疗内痔均安全、有效,并可与息肉切除等其他消化道内镜操作同时完成,不显著增加不良事件。

Objective To investigate the efficacy and safety of different endoscopic treatment strategies for gradeⅠⅢinternal hemorrhoids.Methods Clinical data of 107 internal hemorrhoid patients who received endoscopic sclerotherapy or band ligation in Renmin Hospital of Wuhan University from December 2018 to December 2020 were retrospectively studied.Postoperative adverse events,efficacy,and satisfaction were followed up.Results Among the 107 patients,there were 45 patients(42.06%)with gradeⅠ,55(52.34%)with gradeⅡ,and 6(5.60%)with gradeⅢ.At the same time,94.39%(101/107)patients underwent other gastrointestinal endoscopic treatment.The postoperative follow-up time ranged from 3 to 25 months,with a median of 5 months.A total of 84 patients underwent routine endoscopic injection sclerotherapy,and 8 had adverse events after the surgery.The overall effective rate was 97.61%(82/84),and satisfaction rate was 95.24%(80/84).Nine underwent endoscopic foam sclerotherapy,and no postoperative adverse events were observed.The overall effective rate and the satisfaction rate were both 100.00%(9/9).Among the 11 patients undergoing endoscopic band ligation,2 had adverse events after the surgery.The overall effective rate was 81.82%(9/11),and the satisfaction rate was 72.73%(8/11).Three patients underwent sclerotherapy combined with ligation,and 2 had postoperative adverse events.The overall effective rate was 100.00%(3/3),and the satisfaction rate was 66.67%(2/3).Sclerotherapy was generally superior to ligation in operation cost.Further subgroup analysis for gradeⅠⅡpatients showed that for gradeⅠpatients,sclerotherapy was better than band ligation in the incidence of postoperative pain(P<0.05),and for gradeⅡpatients,no statistically significant differences were observed in adverse events,effective rate and satisfaction rate(P>0.05).Conclusion Both endoscopic injection sclerotherapy and band ligation for internal hemorrhoids are safe and effective,and may not increase the risk of adverse events when simultaneously completed with other gastrointestinal endoscopic treatment.