套扎点数对内痔内镜套扎术安全性及疗效的影响

Effect of the number of ligation points on the safety and efficacy of endoscopic ligation for internal hemorrhoids

摘要:

目的 探讨内痔内镜套扎术中套扎点数对术后相关不良事件及疗效的影响。方法 回顾性分析2020年1月－2021年6月129例就诊于该院，并行内镜下套扎治疗的Ⅰ～Ⅲ度内痔患者的临床资料。按套扎点数分为基础套扎组（n = 51，套扎2至3个点位）和多点套扎组（n = 78，套扎4～7个点位），观察两组患者临床疗效和术后并发症发生情况。结果 临床疗效方面：基础套扎组有效率为88.24%（45/51），与多点套扎组的94.87%（74/78）比较，差异无统计学意义（P > 0.05）。亚分组结果显示，两组患者Ⅰ度内痔疗效比较，差异无统计学意义（P > 0.05），多点套扎组Ⅱ度和Ⅲ度内痔术后疼痛发生率和有效率高于基础套扎组，差异均有统计学意义（P < 0.05）。术后不良事件方面：术后48 h内有73例出现肛门坠胀感，39例出现不同程度疼痛，18例出现排尿困难，1例出现少量出血。与基础套扎组相比，多点套扎组术后48 h疼痛及排尿困难发生率更高（P < 0.05）。结论 内痔内镜套扎术中，套扎位点增多，有增加术后疼痛和排尿困难的风险。对于Ⅰ度内痔，增加套扎位点并不能提高疗效，反而增加了术后出现疼痛的风险，应尽量避免多点套扎。对于Ⅱ度和Ⅲ度内痔，增加套扎位点可提高有效率。

Abstract:

Objective To investigate the effect of the number of ligation points on postoperative adverse events and efficacy of endoscopic ligation for internal hemorrhoids.Methods A retrospective analysis was performed on 129 patients with grade Ⅰ~Ⅲ internal hemorrhoids treated by endoscopic ligation from January 2020 to June 2021. According to the number of ligation points, the two groups were divided into basic ligation group (n = 51, ligation 2 and 3 points) and multi-point ligation group (n = 78, ligation 4 ~ 7 points), and the differences in clinical efficacy and postoperative complications between the two groups were observed.Results Clinical efficacy: the effective rate of basic ligation group was 88.24% (45/51), compared with multi-point ligation group of 94.87% (74/78), the difference was not statistically significant (P > 0.05). Subgroup results were displayed, there was no statistical difference in efficacy of grade I internal hemorrhoids between the two groups (P > 0.05). For grade Ⅱ and Ⅲ hemorrhoids, the incidence of postoperative pain and effective rate in multi-point ligation group were higher than those in basic ligation group (P < 0.05). Postoperative adverse events: within 48 h after surgery, 73 patients experienced anal distension, 39 patients experienced pain of varying degrees, 18 patients experienced dysuria, and 1 patient experienced a small amount of bleeding. The incidence of pain and dysuria was higher in multi-point ligation group than in basic ligation group (P < 0.05).Conclusion In endoscopic ligation for internal hemorrhoids, the increase of ligation sites may increase the risk of postoperative pain and dysuria. For grade Ⅰ hemorrhoids, increasing the number of ligation sites does not improve the outcome, but increases the risk of postoperative pain, and multiple ligation should be avoided as far as possible. For hemorrhoids of grade Ⅱ and Ⅲ, increasing the ligation site can improve the effective rate.