内镜下聚桂醇原液与泡沫硬化注射治疗Ⅱ度出血性内痔的疗效对比

Comparison of endoscopic sclerotherapy with polycinnamol solution and foam injection in the treatment of grade II hemorrhagic internal hemorrhoids

目的对比内镜下聚桂醇原液与泡沫硬化注射治疗Ⅱ度出血性内痔的疗效和安全性。方法收集2020年9月至2021年6月中国科学技术大学附属第一医院消化内科收治的Ⅱ度出血性内痔患者81例,采用随机数字表法分为观察组和对照组,观察组采用聚桂醇原液注射,对照组采用聚桂醇泡沫注射,均进行内镜下硬化治疗。比较分析两组病例的临床资料,观察两组手术操作时间、术后即时止血率、术后并发症(如发热、疼痛、出血和尿潴留等)发生率及随访2、12个月的复发再出血率,对比两组治疗Ⅱ度出血性内痔的效果及安全性。结果两组患者基础资料比较差异无统计学意义(均P>0.05),具有可比性。观察组患者手术操作时间[(7.40±1.18)min]少于对照组[(13.88±0.95)min](P<0.05);观察组患者聚桂醇注射剂量[(5.79±1.61)ml]多于对照组[(4.38±1.92)ml](P<0.05)。观察组术后即时止血率与对照组相同(100%)。观察组术后发热(7.32%)、肛周疼痛(4.88%)、出血(7.32%)、尿潴留(4.88%)并发症发生率与对照组[术后发热(5.00%)、肛门疼痛(7.50%)、出血(7.50%)、尿潴留(2.50%)]差异无统计学意义(均P>0.05)。术后2个月,观察组再出血率(4.88%)与对照组(7.50%),差异无统计学意义(P>0.05),但观察组再出血评分[(1.21±0.63)分]低于对照组[(2.62±0.71)分],差异有统计学意义(P<0.05)。术后12个月,观察组再出血率(2.44%)、再出血评分[(2.33±1.51)分]均低于对照组[再出血率(12.50%)、再出血评分(5.54±2.42)分],差异均有统计学意义(均P<0.05)。结论内镜下硬化治疗Ⅱ度出血性内痔临床疗效确切,聚桂醇原液和泡沫两种不同剂型硬化治疗的术后即时和短期止血率及并发症发生率无明显差异,但原液注射操作更省时,远期复发率更低,值得临床推广应用。

Objective To compare the efficacy and safety of endoscopic sclerotherapy with polycinnamol solution and foam in the treatment of grade II hemorrhagic internal hemorrhoids.Methods From September 2020 to June 2021,81 patients with grade II hemorrhagic internal hemorrhoids were collected from the Department of Gastroenterology,the First Affiliated Hospital of University of Science and Technology of China.They were randomly divided into an observation group and a control group.The observation group was injected with polycinnamol solution,and the control group was injected with polycinnamol foam.All of them were treated with endoscopic sclerotherapy.The clinical data of the two groups were compared and analyzed.The operation time,immediate hemostasis rate,incidence of postoperative complications(such as fever,pain,bleeding and Urinary retention),recurrence and rebleeding rate of the two groups were observed,and the efficacy and safety of the two groups in the treatment of grade II hemorrhagic internal hemorrhoids were compared.Results There was no statistically significant difference in basic data between the two groups of patients(all P>0.05),indicating comparability.The surgical operation time of the observation group patients[(7.40±1.18)min]was shorter than that of the control group[(13.88±0.95)min](P<0.05);The injection dose of polycinnamol[(5.79±1.61)ml]in the observation group was higher than that in the control group[(4.38±1.92)ml](P<0.05).The immediate postoperative hemostasis rate in the observation group was the same as that in the control group(100%).The incidence of postoperative fever(7.32%),perianal pain(4.88%),bleeding(7.32%),and urinary retention(4.88%)complications in the observation group had no significant difference from that in the control group[postoperative fever(5.00%),anal pain(7.50%),bleeding(7.50%),and urinary retention(2.50%)](all P>0.05).Two months after surgery,the rebleeding rate in the observation group(4.88%)was not significantly different from that in the control group(7.50%)(P>0.05),but the rebleeding score in the observation group(1.21±0.63)was lower than that in the control group(2.62±0.71),with a statistically significant difference(P<0.05).The rebleeding rate(2.44%)and the rebleeding score(2.33±1.51)in the observation group were lower than those in the control group[the rebleeding rate(12.50%)and the rebleeding score(5.54±2.42)]at 12 months after follow-up,and the differences were statistically significant(P<0.05).Conclusions Endoscopic sclerotherapy is effective in the treatment of grade II hemorrhagic internal hemorrhoids.There is no significant difference in the immediate and short-term hemostasis rate and the incidence of complications between two different dosage forms of sclerotherapy,namely,polycinnamol solution and foam,but the operation of the solution injection is more time-saving and the long-term recurrence rate is lower,which is worthy of clinical application.