长注射针行透明帽辅助内镜下硬化术治疗内痔伴直肠黏膜内脱垂的疗效及安全性

Efficacy evaluation of cap-assisted endoscopic sclerotherapy with long injection needle in the treatment of internal hemorrhoids with rectal mucosal prolapse

[目的]采用症状联合肛管直肠测压方法评估长注射针行透明帽辅助内镜下硬化术(cap-assisted endoscopic sclerotherapy, CAES)治疗内痔伴直肠黏膜内脱垂的临床疗效及安全性。[方法]入选Ⅰ~Ⅱ度内痔伴直肠黏膜内脱垂患者96例,均使用长10 mm长针行CAES治疗,随访3个月后患者内痔出血、脱出及排便症状改善情况,比较治疗前后肛管直肠测压情况,以及并发症发生及满意度调查。[结果]治疗后3个月患者出血症状、脱出程度及排便症状均较治疗前显著改善,差异有统计学意义(P=0.000);患者肛管残余压、排便感觉各项指标与治疗前比较,均差异有统计学意义(P=0.000),而肛管静息压、肛管缩榨压、力排时直肠排出压与治疗前比较,差异无统计学意义(P=0.398、0.430、0.113)。所有患者术后均无严重并发症发生。95.8%患者对手术满意并愿意推荐给其他患者。[结论]长注射针行透明帽辅助内镜硬化术治疗内痔伴直肠黏膜内脱垂是一种微创、有效、安全的治疗方法,值得临床推广。

[Objective]TTo evaluate the clinical efficacy and safety of cap-assisted endoscopic sclerotherapy(CAES)with long injection needle in the treatment of internal hemorrhoids with rectal mucosal prolapse.[Methods]A total of 96 patients with gradeⅠ-Ⅱinternal hemorrhoids and rectal mucosal prolapse treated were collected.They were treated with CAES with 10 mm length needle.Three months after the treatment,the improvement of internal hemorrhoid bleeding,prolapse and defecation symptoms,anorectal manometry before and after treatment,complications and satisfaction were collected and compared.[Results]Three months after the treatment,the bleeding symptoms,degree of prolapse and defecation symptoms were significantly improved compared with those before the treatment(P=0.000).There were significant differences in anal residual pressure and defecation sensation before and after the treatment(P=0.000),but there was no significant difference in anal resting pressure,anal compression pressure and rectal discharge pressure during forced defecation(P=0.398,0.430 and 0.113).All patients had no postoperative complications.95.8%patients were satisfied with the operation and were willing to recommend it to other patients.[Conclusion]CAES with long injection needle for internal hemorrhoids with rectal mucosal prolapse is a minimally invasive,effective and safe treatment method,which is worthy of clinical promotion.