内镜下氩离子凝固术联合美沙拉嗪灌肠液治疗慢性放射性直肠炎的效果及安全性

Efficacy and safety of endoscopic argon ion coagulation combined with mesalazine enteric fluid in the treatment of chronic radiation proctitis

目的探讨内镜下氩离子凝固术联合美沙拉嗪灌肠液治疗慢性放射性直肠炎伴出血患者的效果及安全性。方法回顾性病例对照研究。回顾性分析2019年1月至2022年1月山西省肿瘤医院收治的82例慢性放射性直肠炎伴出血患者的临床资料,根据治疗方法不同分为观察组(44例,内镜下氩离子凝固术联合美沙拉嗪灌肠液保留灌肠)和对照组(38例,0.9%NaCl溶液20 ml+凝血酶1000 U联合美沙拉嗪灌肠液保留灌肠)。比较治疗1个月后两组的临床疗效、直肠镜评分、实验室指标[C反应蛋白(CRP)、血红蛋白(Hb)]及两组治疗期间不良反应的发生情况。结果两组患者性别、年龄、体质量指数、病种分类比较,差异均无统计学意义(均P>0.05)。治疗1个月后,观察组总有效率高于对照组[93.18%(41/44)比76.32%(29/38)],差异有统计学意义(χ2=4.64,P=0.031)。观察组肠道损伤程度、肛门疼痛、肉眼血便程度均低于对照组(均P<0.05)。两组治疗1个月后CRP水平均低于治疗前,Hb水平均高于治疗前(均P<0.001),但两组间治疗前及治疗1个月后CRP、Hb水平分别比较,差异均无统计学意义(均P>0.05)。两组不良反应发生情况比较,差异无统计学意义(P>0.05)。结论内镜下氩离子凝固术联合美沙拉嗪灌肠液治疗慢性放射性直肠炎伴出血的效果较好,能够改善患者便血、腹泻、贫血等症状,提高生命质量,且安全性较高。

Objective To investigate the efficacy and safety of endoscopic argon ion coagulation combined with mesalazine enteric fluid in the treatment of chronic radiation proctitis with hemorrhage.Methods A retrospective case control study was conducted.The clinical data of 82 patients with chronic radiation proctitis with hemorrhage admitted to Shanxi Province Cancer Hospital from January 2019 to January 2022 were retrospectively analyzed.According to the treatment methods,all patients were divided into the observation group(endoscopic argon ion coagulation combined with mesalazine enteric fluid retention enema,44 cases)and the control group(0.9%NaCl solution 20 ml+thrombin 1000 U combined with mesalazine enteric fluid retention enema,38 cases).The clinical efficacy,proctoscopy scores,laboratory indexes[C-reactive protein(CRP),hemoglobin(Hb)]and the adverse reactions of the two groups 1 month after treatment were compared.Results There were no statistically significant differences in gender,age,body mass index and disease classification between the two groups(all P>0.05).After 1 month of treatment,the total effective rate of the observation group was higher than that of the control group[93.18%(41/44)vs.76.32%(29/38)],and the difference was statistically significant(χ2=4.64,P=0.031).The degree of intestinal injury,anal pain and naked blood stool in the observation group were lower than those in the control group(all P<0.05).The level of CRP 1 month after treatment was lower than that before treatment in both groups,and the level of Hb 1 month after treatment was higher than that before treatment in both groups(all P<0.001);and there were no statistically significant differences in the levels of CRP ahd Hb before treatment and 1 month after treatment between the both groups(all P>0.05).There was no statistically significant difference in the adverse reactions between the two groups(P>0.05).Conclusions Endoscopic argon ion coagulation combined with mesalazine enteric fluid in the treatment of chronic radiation proctitis with hemorrhage has a favorable effect and a good safety,which can improve the symptoms of hematochezia,diarrhea,anemia and improve the quality of life of patients.