| 摘要: |
| ［摘要］ 目的 观察透明帽辅助内镜下注射高剂量聚桂醇泡沫硬化剂治疗Ⅱ～Ⅲ度内痔的效果。方法 招募2022年10月至2023年10月于长安医院接受透明帽辅助内镜下注射聚桂醇泡沫硬化剂治疗的Ⅱ～Ⅲ度内痔患者98例，采用随机数字表法将其分为常规剂量组和高剂量组，每组49例。常规剂量组聚桂醇泡沫硬化剂注射剂量为0.5～2.0 mL/注射位点，高剂量组聚桂醇泡沫硬化剂注射剂量为>2.0～4.0 mL/注射位点。比较两组治疗效果、治疗相关指标、术后并发症发生情况以及复发情况。于治疗前、治疗后1个月、治疗后3个月比较两组血清炎症指标［肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、白细胞介素-6（IL-6）］、肛肠动力学指标［直肠最大耐受量（MTV）、直肠静息压（RRP）、肛管最大收缩压（MSP）］、肛门控便功能评分、肛门感觉功能评分以及EuroQol五维调查问卷表（EQ-5D）评分。结果 两组疗效比较差异有统计学意义（P<0.05），高剂量组治愈人数比例较常规剂量组更高（79.59% vs 59.18%）。高剂量组住院时间显著短于常规剂量组（P<0.05）。治疗后两组TNF-α、CRP、IL-6、MTV、MSP水平以及肛门控便功能评分、肛门感觉功能评分均呈下降趋势，RRP水平、EQ-5D评分呈上升趋势，且高剂量组变化幅度更大（P<0.05）。在治疗后1个月和3个月，高剂量组TNF-α、CRP、IL-6、MTV、MSP水平以及肛门控便功能评分、肛门感觉功能评分均低于常规剂量组，RRP水平和EQ-5D评分高于常规剂量组，差异有统计学意义（P<0.05）。两组术后并发症总发生率比较差异无统计学意义（10.20% vs 6.12%； χ2=0.544，P=0.461）。治疗后随访6个月，高剂量组无复发病例，常规剂量组复发6例，高剂量组复发率显著低于常规剂量组（0.00% vs 12.24%； χ2=6.391，P=0.011）。结论 透明帽辅助内镜下注射高剂量聚桂醇泡沫硬化剂治疗Ⅱ～Ⅲ度内痔可提高治愈率，抑制炎症反应，促进肛肠动力学恢复，改善肛门功能，提高生活质量，降低复发率，值得临床推荐。 |
| 关键词: 内痔 聚桂醇 内镜 疗效 肛门功能 生活质量 |
| DOI：10.3969/j.issn.1674-3806.2024.10.10 |
| 分类号:R 657.1+8 |
| 基金项目:陕西省重点研发计划项目（编号：2021SF-031） |
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| Observation on the effect of transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent at a high dose in treatment of grade Ⅱ-Ⅲ internal hemorrhoids |
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SHI Jie, LI Wenzhong, ZHOU Yi, ZHOU Qingwen
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Department of Gastroenterology, Chang An Hospital, Xi′an 710016, China
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| Abstract: |
| ［Abstract］ Objective To observe the effect of transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent at a high dose in treatment of grade Ⅱ-Ⅲ internal hemorrhoids. Methods A total of 98 patients with grade Ⅱ-Ⅲ internal hemorrhoids who received the treatment of transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent in Chang An Hospital from October 2022 to October 2023 were recruited and divided into conventional-dose group and high-dose group by using random number table method, with 49 cases in each group. The injection dose of polidocanol foam sclerosing agent in the conventional-dose group was 0.5-2.0 mL/injection site, and the injection dose of polidocanol foam sclerosing agent in the high-dose group was more than 2.0-4.0 mL/injection site. The therapeutic effect, treatment-related indicators, the occurrence of postoperative complications and the recurrence were compared between the two groups. The serum inflammatory indicators［tumor necrosis factor-alpha(TNF-α), C-reactive protein(CRP), interleukin-6(IL-6)］, anorectal dynamics indicators［rectal maximum tolerated volume(MTV), rectal resting pressure(RRP), anal maximum squeeze pressure(MSP)］, anal continence function score, anal sensory function score, and EuroQol five-dimensional questionnaire(EQ-5D) score were compared between the two groups before treatment, 1 month after treatment and 3 months after treatment. Results The difference in therapeutic efficacy between the two groups was statistically significant(P<0.05), and the proportion of the patients cured in the high-dose group was higher than that in the conventional-dose group(79.59% vs 59.18%). The length of hospital stay in the high-dose group was significantly shorter than that in the conventional-dose group(P<0.05). After treatment, the levels of TNF-α, CRP, IL-6, MTV, MSP, anal continence function scores and anal sensory function scores in both groups showed a downward trend, while the levels of RRP and EQ-5D scores in both groups showed an upward trend, and the changes were greater in the high-dose group(P<0.05). At 1 month and 3 months after treatment, the levels of TNF-α, CRP, IL-6, MTV, MSP, anal continence function scores and anal sensory function scores in the high-dose group were lower than those in the conventional-dose group, while the RRP level and EQ-5D scores in the high-dose group were higher than those in the conventional-dose group, and the differences were statistically significant(P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups(10.20% vs 6.12%; χ2=0.544, P=0.461). The follow-up was conducted for 6 months after treatment, and there were no cases of recurrence in the high-dose group, while there were 6 cases of recurrence in the conventional-dose group, and the recurrence rate in the high-dose group was significantly lower than that in the conventional-dose group(0.00% vs 12.24%; χ2=6.391, P=0.011). Conclusion Transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent at a high dose can improve the cure rate in treatment of grade Ⅱ-Ⅲ internal hemorrhoids, inhibit the inflammatory response, promote the recovery of anorectal dynamics, improve the anal function, improve the quality of life, and reduce the recurrence rate, and is worthy of clinical recommendation. |
| Key words: Internal hemorrhoid Polidocanol Endoscope Therapeutic effect Anal function Quality of life |
