聚多卡醇泡沫硬化剂治疗62例特殊痔患者的短期临床疗效和安全性分析

Short-term clinical effectiveness and safety analysis of polidocanol foam sclerotherapy in the treatment of 62 exceptional patients with hemorrhoids

目的分析聚多卡醇泡沫硬化剂治疗特殊痔患者的短期临床疗效和安全性。方法收集2021年8月至2023年11月在长江大学附属荆州医院采用聚多卡醇泡沫硬化剂注射治疗的62例特殊痔患者的临床资料进行回顾性分析,其中包括慢性肾衰竭尿毒症期,肝癌晚期,肺癌晚期,白血病非稳定期,淋巴瘤化疗期,重度贫血且不愿意接受输血治疗,凝血功能障碍,严重心脑血管疾病且不宜停用抗凝药物的患者。分析手术时间,术前和术后1个月的痔患者健康量表短表评分、Wexner便秘评分,临床疗效(于术后1周、术后1个月进行评价),术后第1天的肛门疼痛,不良反应,以及患者对治疗的满意率(于术后1个月进行评价)。部分患者在首次治疗后1个月内接受了第2次的治疗,术后的评价时间点根据接受首次治疗的时间开始推算。结果62例患者中,平均手术时间为(12.1±2.3)min。术后1个月的痔患者健康量表短表评分和Wexner便秘评分低于术前,差异有统计学意义(P<0.05)。术后1周的治疗总有效率为93.5%(58/62),术后1个月的治疗总有效率为96.8%(60/62)。术后第1天,16例术前存在肛门疼痛的患者诉疼痛较前缓解,46例术前不存在肛门疼痛的患者中有17例诉存在轻微的肛门疼痛。所有患者均未出现过敏、发热、局部感染或脓肿形成。术后1个月,患者对治疗的满意率为95.2%(59/62)。结论聚多卡醇泡沫硬化剂注射治疗可以考虑作为手术、麻醉风险高的特殊痔患者的治疗方法,短期临床疗效和安全性良好。

Objectives To analyze the short-term clinical effectiveness and safety of polidocanol foam sclerotherapy in the treatment of exceptional patients with hemorrhoids.Methods A retrospective analysis was conducted on the clinical data of 62 exceptional patients with hemorrhoids treated with polidocanol foam sclerotherapy at Jingzhou Hospital Affiliated to Yangtze University from August 2021 to November 2023.These patients included those with chronic renal failure in uremic stage,advanced liver cancer,advanced lung cancer,unstable leukemia,lymphoma during chemotherapy,severe anemia refusing blood transfusion,coagulation dysfunction,and severe cardiovascular and cerebrovascular diseases with contraindications for anticoagulation drug withdrawal.The operative time,pre-and post-operative(1-month)Short Health Scale for hemorrhoidal disease(SHS_(HD))score,Wexner constipation score,clinical effectiveness(evaluated at 1 week and 1 month post-surgery),anal pain on postoperative day 1,adverse reactions,and patient satisfaction rate(evaluated at 1 month post-surgery)were analyzed.Some patients received a second treatment within 1 month after the first treatment,and the time points for post-operative evaluation were calculated from the time of first treatment.Results Among the 62 patients,the mean operative time was(12.1±2.3)minutes.The SHSHD score and Wexner constipation score were significantly lower at 1 month post-surgery compared to pre-surgery(P<0.05).The overall effective rate was 93.5%(58/62)at 1 week post-surgery and 96.8%(60/62)at 1 month post-surgery.On postoperative day 1,16 patients with pre-existing anal pain reported improvement,while 17 of the 46 patients without pre-existing anal pain reported mild anal pain.No allergic reactions,fever,local infections,or abscess formation were observed in any patients.The patient satisfaction rate was 95.2%(59/62)at 1 month post-surgery.Conclusion Polidocanol foam sclerotherapy can be considered as a treatment option for exceptional patients with hemorrhoids who have high surgical and anesthesia risks,demonstrating good short-term clinical effectiveness and safety.