内镜下泡沫硬化剂治疗Ⅰ～Ⅲ度内痔的随机对照试验

Efficacy of endoscopic foam sclerosant versus liquid sclerotherapy for degree Ⅰ~Ⅲ internal hemorrhoids: a randomized controlled trail

摘要:

目的 比较泡沫硬化剂（FS）及液体硬化剂（LS）治疗Ⅰ～Ⅲ度内痔的短期有效性和安全性。方法 选择连续就诊于该院的Ⅰ～Ⅲ度内痔患者（18～70岁），采用随机数表法分为LS组和FS组，术前均完成全结肠镜检查，分别在透明帽辅助下行FS和LS注射治疗。记录药物聚多卡醇的使用剂量、注射位点数和拔针时渗血情况等，以及术后随访24 h肛周疼痛情况和12周治疗有效性。结果 共纳入108例患者，年龄（52.3±12.6）岁，男59例（54.6%）。FS组56例，LS组52例，两组基线资料比较，差异无统计学意义。FS组中，无效2例，显效10例，治愈44例，治愈率78.6%；LS组中，无效3例，显效19例，治愈30例，治愈率57.7%，FS组治愈率明显高于LS组（χ² = 5.45，P = 0.023）。且FS组中，Ⅰ度和Ⅱ度内痔患者的治疗效果明显优于LS组。FS组治疗所需药物原液总量为（2.9±1.4）mL，明显少于LS组的（6.4±1.7）mL，减少了54.7%，差异有统计学意义（P = 0.000）。结论 FS治疗较LS治疗Ⅰ～Ⅲ度内痔，疗效好，安全性更高，同时可以减少患者医疗支出费用，适合在临床工作中推广。

Abstract:

Objective To compare the short-term efficacy and safety of foam sclerotherapy (FS) and liquid sclerotherapy (LS) in treatment of degree Ⅰ~Ⅲ internal hemorrhoids.Methods The patients (18~70 years old) with degree Ⅰ~Ⅲ internal hemorrhoids who were continuously treated were selected, and divided into group LS and group FS by random numbers. All the patients need to accepted colonoscopy before surgery. FS and LS of hemorrhoids were injected by the cap-assisted colonic endoscopy. The total amount of polidocanol injection, number of injection points, the bleeding during needle extraction were recorded. The patients were followed up 24 h for perianal pain and 12 weeks after treatment to reevaluate patient’s condition.Results 108 patients aged (52.3 ± 12.6) years were enrolled in this study, of which 59 were male (54.6%), 56 patients were random into the FS group and 52 patients were into the LS group. There were no significant differences in the two groups in any baseline characteristics. In the group FS, 2 cases were invalid, 10 cases were significant effective and 44 cases were cured, the cure effective rate was 78.6%, while in the group LS, the number were 3, 19 and 30, and the significant effective rate was 57.7%. The cure rate of group FS was higher than that of group LS (χ² = 5.45, P = 0.023). The therapeutic efficacy of internal hemorrhoids with degree Ⅰ and Ⅱ in group FS was significantly better than that in LS group. The total amount of drug stock solution required for treatment in the FS group (2.9 ± 1.4) mL was significantly lower than that in the group LS (6.4 ± 1.7) mL, with a decrease of 54.7%, and the difference was statistically significant (P = 0.000).Conclusion FS in the treatment of degree I~III internal hemorrhoids has high efficacy and safety compared to the LS, meanwhile, it can also reduce the medical expenses, which is suitable for promotion in clinical work.