内镜硬化剂注射术联合套扎术治疗内痔的疗效及预后影响因素分析

Analysis of the curative effect and prognostic factors of endoscopic sclerosing agent injection combined with ligation for patients with internal hemorrhoid

目的探讨内镜硬化剂注射术联合套扎术治疗内痔的疗效及影响预后的因素。方法前瞻性纳入2018年1月-2021年6月该院收治的内痔患者150例,采用随机数表法分为对照组(单纯内镜套扎术治疗)和观察组(内镜硬化剂注射术联合套扎术治疗),每组75例。比较两组患者临床疗效、手术情况和术后并发症发生率。以患者预后情况为依据,分为预后良好组和预后不良组,采用多因素Logistic回归模型,筛选预后不良的影响因素,构建风险预测模型,并评价模型效能。结果观察组总有效率明显高于对照组,手术时间明显长于对照组,术中出血量明显少于对照组,视觉模拟评分(VAS)和术后并发症总发生率明显低于对照组,愈合时间明显短于对照组,差异均有统计学意义(P<0.05)。多因素Logistic分析结果显示,年龄、病程、病情严重程度、饮食习惯、术中出血量和排便时间是内痔患者预后不良的独立危险因素(P<0.05)。构建的列线图预测模型具有较高的区分度和校准度。结论治疗内痔时,内镜硬化剂注射术联合套扎术较单独内镜套扎术疗效更好,并发症更少。高龄、病程长、病情严重、饮食辛辣、术中出血量大和术后过早排便是内痔患者预后不良的影响因素,临床应重点关注该类患者。

Objective To explore the efficacy and prognostic factors of endoscopic sclerosing agent injection combined with ligation in treatment of patients with internal hemorrhoid.Methods 150 patients with internal hemorrhoid from January 2018 to June 2021 were prospectatively included and divided into control group(endoscopic ligation alone)and observation group(endoscopic sclerosing agent injection combined ligation treatment)by random number table method,with 75 cases in each group.The clinical efficacy,operation situation and incidence of postoperative complications were compared.According to the prognosis,patients were divided into good prognosis group and poor prognosis group.Multivariate Logistic regression was used to screen the influencing factors of poor prognosis,build a risk prediction model and evaluate the effectiveness of the model.Results The total cure rate of observation group was significantly higher than that of control group,the operation time was significantly longer than that of control group,while the intraoperative blood loss was significantly less than that of control group,visual analogue scale(VAS)and the total incidence of postoperative complications were significantly lower than those of control group,the healing time was significantly shorter than that of control group,the differences were statistically significant(P<0.05).Multivariate Logistic analysis showed that age,course of disease,severity of disease,dietary habits,intraoperative blood loss and defecation time were independent risk factors for poor prognosis of patients with internal hemorrhoid after treatment(P<0.05).The nomogram prediction model had higher discrimination and calibration degree.Conclusion In the treatment of internal hemorrhoids,endoscopic ssclerosing agent injection combined with ligation has better efficacy and fewer complications than endoscopic ligation alone.Advanced age,long course of disease,serious condition,spicy diet,large amount of intraoperative blood loss and premature defecation after operation are the influencing factors of poor prognosis of patients with internal hemorrhoid.Clinical attention should be paid to these patients.