肝硬化出血性内痔患者内痔内镜套扎术联合内镜下硬化剂注射治疗的疗效及安全性评价

Evaluation of the efficacy and safety of endoscopic ligation for internal hemorrhoids combined with endoscopic injection sclerotherapy in the treatment of hemorrhoidal bleeding patients with liver cirrhosis

摘要:

目的 探讨内痔内镜套扎术联合内镜下硬化剂注射治疗在出血性内痔合并肝硬化患者中的疗效及安全性。方法 回顾性分析2020年12月－2025年3月该院收治的60例出血性内痔合并肝硬化患者的临床资料，按实际治疗方案不同，分为套扎组（n = 30）和联合组（n = 30）。比较两组手术时间、术中出血量、创面愈合时间、住院时间、术后不同时间点疼痛视觉模拟评分法（VAS）评分、临床疗效（治愈率及总有效率）和术后并发症发生情况。结果 与套扎组相比，联合组术中出血量更少，创面愈合时间和住院时间更短，术后12 h、1 d、3 d和7 d的VAS评分更低，治愈率和总有效率更高，术后并发症总发生率更低，差异均有统计学意义（P 0.05）。结论 在出血性内痔合并肝硬化患者的治疗中，内痔内镜套扎术联合内镜下硬化剂注射治疗较单纯内痔内镜套扎术可减少术中出血，减轻术后疼痛，促进术后恢复，减少并发症的发生，且临床疗效好。值得应用于临床。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic ligation for internal hemorrhoids combined with endoscopic injection sclerotherapy for hemorrhoidal bleeding in patients with liver cirrhosis.Methods We retrospectively enrolled 60 patients with hemorrhoidal bleeding and concomitant liver cirrhosis treated in our hospital between December 2020 and March 2025. Patients were allocated to an endoscopic ligation for internal hemorrhoids group (ligation group, n = 30) or an endoscopic ligation for internal hemorrhoids plus endoscopic injection sclerotherapy group (combined group, n = 30) according to the actual endoscopic regimen. Intraoperative blood loss, procedure time, wound healing time, length of hospital stay, visual analogue scale (VAS) scores for pain at multiple postoperative time points, clinical efficacy (cure rate and overall response), and postoperative complications were compared.Results Compared with the ligation group, the combined group had less intraoperative blood loss, shorter wound healing time and hospital stay, lower VAS scores at 12 h, 1 d, 3 d and 7 d after treatment, higher cure rate and overall response, and lower overall complication rate, the differences were statistically significant (P 0.05).Conclusion For liver cirrhosis patients with hemorrhoidal bleeding, endoscopic ligation for internal hemorrhoids combined with endoscopic injection sclerotherapy provides superior perioperative hemostasis, less pain, faster recovery, and fewer complications than endoscopic ligation for internal hemorrhoids alone. It is worth applying in clinical practice.