自动痔套扎联合硬化剂注射治疗Ⅱ度和Ⅲ度内痔的临床研究

Clinical study of automatic hemorrhoidal banding combined with sclerotherapy for the treatment of second-and third-degree internal hemorrhoids

目的研究自动痔套扎(RPH)联合硬化剂注射治疗Ⅱ度和Ⅲ度内痔的临床效果。方法2019年3月~2022年9月我院收治Ⅱ度和Ⅲ度内痔156例,按照随机数字表法分为3组,即痔结扎组、RPH组、RPH+硬化剂注射组,每组各52例,3组分别行痔结扎术、RPH术、RPH+硬化剂注射术。比较3组的手术时间、住院时间、痔块脱落时间、术后出血、术后肛门坠胀、术后肛缘水肿、术后肛门狭窄等指标。结果3组病人有效率均达100%。痔结扎组手术时间、住院时间、痔块脱落时间方面分别为(34.13±5.80)分钟、(8.65±0.96)天和(5.94±0.46)天,RPH组分别为(22.81±1.95)分钟、(6.58±0.75)天、(8.02±0.43)天,RPH+硬化剂注射组分别为(23.73±2.02)分钟、(6.46±0.75)天、(8.00±0.56)天,RPH及RPH+硬化剂注射组与痔结扎组比较,痔块脱落时间延长,手术时间、住院时间缩短,差异有统计学意义(P<0.05)。痔结扎组术后出血为(177.40±30.45)ml,RPH组为(105.44±15.92)ml,RPH+硬化剂注射组为(59.46±14.99)ml,RPH组和RPH+硬化剂注射组病人出血量显著少于痔结扎组,差异有统计学意义(P<0.05),RPH+硬化剂注射组病人出血量少于RPH组,差异有统计学意义(P<0.05)。痔结扎组术后肛门坠胀15例,RPH组为10例,RPH+硬化剂注射组为7例,RPH组和RPH+硬化剂注射组病人肛门坠胀少于痔结扎组,差异有统计学意义(P<0.05)。痔结扎组术后肛缘水肿、肛门狭窄3例、0例,RPH组为2例、0例,RPH+硬化剂注射组为3例、0例,3组比较,差异均无统计学意义(P>0.05)。结论RPH联合硬化剂注射术能降低病人术后出血、住院时间、术后肛门坠胀,术后效果满意。

Objective To study the clinical effects of automatic hemorrhoidal banding(RPH)combined with sclerosing agent injection in the treatment of second-and third-degree internal hemorrhoids.Methods A total of 156 cases of second-degree and third-degree internal hemorrhoids were randomly divided into three groups,namely hemorrhoidal ligation group,RPH group,and(RPH+sclerotherapy injection)group,with 52 cases in each group,and the three groups underwent hemorrhoidal ligation,RPH surgery,and(RPH+sclerotherapy injection)respectively.The surgical effect was evaluated by the three groups such as operation time,hospital stay,hemorrhoidal lump shedding time,postoperative bleeding,postoperative swelling,postoperative margin edema,and postoperative stenosis.Results After treatment,the effective rate of all three groups reached 100%.In terms of operation time,hospital stay and hemorrhoidal lump shedding time,the hemorrhoidal ligation group was(34.13±5.80)min,(8.65±0.96)d,(5.94±0.46)d,the RPH group was(22.81±1.95)min,(6.58±0.75)d,(8.02±0.43)d,the(RPH+sclerotherapy injection)group was(23.73±2.02)min,(6.46±0.75)d,(8.00±0.56)d,RPH and(RPH+sclerotherapy injection)group compared with hemorrhoidal ligation group,hemorrhoidal mass shedding time,surgery time and hospital stay shortened,and all were statistically significant(P<0.05),and the(RPH+sclerotherapy injection)group had less hospital stay than RPH group(P<0.05).In terms of postoperative bleeding,the hemorrhoidal ligation group was(177.40±30.45)ml,the RPH group was(105.44±15.92)ml,the(RPH+sclerotherapy injection)group was(59.46±14.99)ml,the amount of blood loss in the RPH group and the(RPH+sclerotherapy injection)group was less than that in the hemorrhoidal ligation group(P<0.05),and the blood loss in the(RPH+sclerotherapy injection)group was significantly less than that in the RPH group(P<0.05).In terms of postoperative swelling,the hemorrhoidal ligation group was 15 cases,the RPH group was 10 cases,the(RPH+sclerotherapy injection)group was 7 cases,the swelling in the RPH group and the(RPH+sclerotherapy injection)group was significantly less than that in the hemorrhoidal ligation group(P<0.05)。In terms of postoperative edema and stenosis,the hemorrhoidal ligation group was 3 cases and 0 case,RPH group was 2 cases and 0 case,and(RPH+sclerotherapy injection)group was 3 cases and 0 case,and there was no significant difference between the three surgical methods(P>0.05).Conclusion RPH combined with sclerosing injection can significantly reduce the postoperative bleeding,hospital stay,and postoperative swelling,and the postoperative effect is satisfactory,which provides a reliable basis for the clinical treatment of Ⅱ and Ⅲ.degree internal hemorrhoids.