CAES治疗Ⅰ~Ⅲ度出血性内痔的效果及其术后复发影响因素

Effect of transparent cap-assisted endoscopic sclerotherapy in the treatment of gradeⅠ-Ⅲhemorrhagic internal hemorrhoids and the factors affecting postoperative recurrence.

目的观察透明帽辅助内镜下硬化术(CAES)治疗Ⅰ~Ⅲ度出血性内痔的效果,并探讨其术后复发的影响因素。方法回顾性分析2020年3月至2023年3月于河南大学第一附属医院均行CAES治疗的100例Ⅰ~Ⅲ度出血性内痔患者的临床资料,统计患者围术期指标、并发症发生率及术后12个月复发率,根据术后12个月复发率分为复发组16例和未复发组84例,比较两组患者的一般资料、围术期指标和实验室指标[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞(WBC)],采用Lasso-COX回归模型筛选Ⅰ~Ⅲ度出血性内痔术后复发的独立影响因素。结果术后1个月患者的并发症总发生率为6.00%(6/100),其中1例肛门坠胀,1例出血,3例排便困难,1例感染;复发组患者的内痔分度Ⅲ度占比、便秘发生率和糖尿病发生率分别为50.00%、62.50%、31.25%,明显高于未复发组的8.33%、19.05%、7.14%,差异均有统计学意义(P<0.05);复发组患者术后1个月的CRP、IL-6、WBC分别为(26.64±2.88)mg/L、(20.12±3.05)pg/mL、(9.45±1.01)×109/L,明显高于未复发组的(20.12±3.56)mg/L、(11.74±2.08)pg/mL、(5.53±0.56)×109/L,差异均有统计学意义(P<0.05);依据最佳惩罚系数λ=5选出6个预测变量为便秘、糖尿病及术后1个月CRP、IL-6、WBC水平,经COX回归方程显示,便秘、糖尿病及术后1个月CRP、IL-6、WBC水平是Ⅰ~Ⅲ度出血性内痔术后复发影响因素(P<0.05)。结论便秘、糖尿病及术后1个月的CRP、IL-6、WBC水平是影响Ⅰ~Ⅲ度出血性内痔术后复发的影响因素。

Objective To observe the effect of transparent cap-assisted endoscopic sclerotherapy(CAES)in the treatment of gradeⅠ-Ⅲhemorrhagic internal hemorrhoids,and to explore the factors affecting postoperative recurrence.Methods The clinical data of 100 patients with gradeⅠ-Ⅲhemorrhagic internal hemorrhoids who underwent CAES treatment at the First Affiliated Hospital of Henan University from March 2020 to March 2023 were retrospectively analyzed.The perioperative indicators,complication rate,and recurrence rate at 12 months after surgery were statistically analyzed.According to the recurrence rate at 12 months after surgery,the patients were divided into a recurrence group(16 cases)and a non-recurrence group(84 cases).The general data,perioperative indicators,laboratory indicators[C-reactive protein(CRP),interleukin-6(IL-6),white blood cells(WBC)]of the two groups were compared.Lasso-COX regression model was used to screen independent factors that affect the recurrence of gradeⅠ-Ⅲhemorrhagic internal hemorrhoids after surgery.Results The total incidence of complications one month after surgery was 6.00%(6/100),including 1 case of anal prolapse,1 case of bleeding,3 cases of difficulty in defecation,and 1 case of infection.The proportion of gradeⅢof internal hemorrhoids,the incidence of constipation,and the incidence of diabetes in the recurrence group were 50.00%,62.50%,and 31.25%,respectively,which were significantly higher than 8.33%,19.05%,and 7.14%in the non-recurrence group(P<0.05).The CRP,IL-6,and WBC of patients in the recurrence group after 1 month of surgery were(26.64±2.88)mg/L,(20.12±3.05)pg/mL,and(9.45±1.01)×109/L,respectively,which were significantly higher than(20.12±3.56)mg/L,(11.74±2.08)pg/L,and(5.53±0.56)×109/L in the non-recurrence group(P<0.05).Based on the optimal penalty coefficientλ=5,predictors were selected as constipation,diabetes,and the levels of CRP,IL-6,and WBC at one month after operation.The COX regression equation showed that constipation,diabetes,and the levels of CRP,IL-6,and WBC at one month after operation were the influencing factors for postoperative recurrence of gradeⅠtoⅢhemorrhoids(P<0.05).Conclusion Constipation,diabetes,and CRP,IL-6,WBC levels at one month after operation are the influencing factors for postoperative recurrence of gradeⅠtoⅢhemorrhagic internal hemorrhoids.