聚多卡醇泡沫硬化剂对于进展期内痔患者术后恢复的疗效

Efficacy of polidocanol foam sclerotherapy in treatment of patients with advanced hemorrhoids

背景痔疮是临床常见肛肠疾病,主要症状为便血、便秘、肿胀等.Ⅲ-Ⅳ期内痔症状较严重,临床治疗以手术为主,但手术治疗效果仍不尽理想.聚多卡醇泡沫硬化注射能使内痔血管发生纤维化闭塞和体积萎缩,具有治疗痔疮的作用.目的探究聚多卡醇泡沫硬化剂注射联合自动痔疮套扎术(receive playload handler,RPH)治疗Ⅲ-Ⅳ期内痔的疗效.方法将2020-05/2022-05我院180例Ⅲ-Ⅳ期内痔患者随机分为对照组和研究组,各90例.对照组采用RPH治疗,研究组采用聚多卡醇泡沫硬化剂注射联合RPH治疗.比较两组治疗效果、围术期指标、血清生化指标、肛门功能、肛门疼痛程度、肛门狭窄程度、血管形态学指标、并发症及复发率.结果研究组治愈率高于对照组(P<0.05);研究组术后便血持续时间、住院时间短于对照组(P<0.05);研究组术后第3 d、7 d血清白介素-8、白介素-22、CXC型趋化因子受体4水平低于对照组(P<0.05);术后第3 d、7 d,研究组肛门控便、感觉、闭合功能评分低于对照组(P<0.05);研究组术后第3 d、7 d肛门疼痛、狭窄程度评分低于对照组(P<0.05);术后第7 d,研究组肛周静脉丛曲张面积、直径低于对照组(P<0.05);研究组并发症发生率、复发率低于对照组(P<0.05).结论聚多卡醇泡沫硬化剂注射联合RPH治疗Ⅲ-Ⅳ期内痔的疗效显著,能更有效减轻术后肛门疼痛,改善肛周血管形态学.

BACKGROUND Hemorrhoids are common clinical anorectal diseases,the main symptoms of which are bloody stool,constipation,swelling,etc.The symptoms of stageⅢ-Ⅳhemorrhoids are more serious,and the clinical treatment is mainly surgery,but the effect of surgical treatment is still not satisfactory.Polydocaol foam sclerotherapy can result in fibrotic occlusion and volume atrophy of the blood vessels in internal hemorrhoids,thus having therapetuic effect on hemorrhoids.AIM To explore the efficacy of polydocanol foam sclerosing agent injection combined with receive playload handler(RPH)in the treatment of stageⅢ-Ⅳinternal hemorrhoids.METHODS One hundred and eighty patients with stageⅢ-Ⅳinternal hemorrhoids were randomly divided into a control group and a study group,with 90 cases in each group.The control group was treated with RPH,and the study group was treated with polydocanol foam sclerosing agent injection combined with RPH.The therapeutic effect,perioperative indicators,serum biochemical indicators[interleukin-8(IL-8),interleukin-22(IL-22),and CXC type chemokine receptor 4(CXCR4)],anal function,anal pain,anal stenosis,vascular morphological indicators,complications,and recurrence rate were compared between the two groups.RESULTS The cure rate of the study group was higher than that of the control group(P<0.05).The durations of postoperative rectal bleeding,hospital stay,and wound healing time in the study group were shorter than those of the control group(P<0.05).The levels of serum IL-8,IL-22,and CXCR4 in the study group were lower than those of the control group on the 3rd and 7th postoperative days(P<0.05).On the 3rd and 7th postoperative days,the scores of anal control,sensation,and closure function in the study group were lower than those of the control group(P<0.05).The study group had lower scores for anal pain and stenosis on the 3rd and 7th postoperative days compared to the control group(P<0.05).On the 7th day after surgery,the square measure and diameter of perianal varicose veins in the study group were lower than those of the control group(P<0.05).The incidence and recurrence rates of complications in the study group were lower than those of the control group(P<0.05).CONCLUSION Polydocanol foam sclerosing agent injection combined with RPH is effective in the treatment of stageⅢ-Ⅳinternal hemorrhoids,and can more effectively alleviate postoperative anal pain and improve the morphology of perianal vessels.