透明帽辅助内镜下注射聚桂醇泡沫硬化剂治疗13例出血性内痔的临床观察(1)
摘 要 目的：观察透明帽辅助内镜下注射聚桂醇泡沫硬化剂治疗出血性内痔的临床疗效和安全性。方法：对13例Ⅰ～Ⅲ度出血性内痔患者施行透明帽辅助内镜下注射聚桂醇泡沫硬化剂治疗，必要时联合胶圈套扎治疗，观察治疗效果、患者的术后并发症和满意度。结果：13例患者中，10例接受注射硬化剂治疗，3例接受注射硬化剂联合胶圈套扎治疗。术后12周随访，10例(76.9%)治愈，3例(23.1%)有效。在10例单纯注射硬化剂治疗的患者中，3例(30.0%)有轻至中度疼痛；在3例联合胶圈套扎治疗的患者中，2例(66.7%)疼痛需药物缓解。所有患者术后均无其他严重并发症。患者满意度高(100.0%)。结论：透明帽辅助经胃镜倒镜操作注射聚桂醇泡沫硬化剂治疗出血性内痔操作方便、安全性高，患者痛苦轻、恢复快，具有进一步研究和临床应用的价值。
关键词 出血性内痔 透明帽辅助内镜下硬化术 胶圈套扎
中图分类号：R657.18 文献标志码：B 文章编号：1006-1533(2020)09-0017-06
Clinical observation of the cap-assisted endoscopic lauromacrogol foam sclerotherapy in bleeding internal hemorrhoids
CHEN Ying1*， CHEN Wei1， FANG Qingqing1， ZHANG Junpei1， JIAN Yourong1， ZHU Zihua1， TIAN Yi1， CHEN Shiyao1， 2**
[1. Department of Gastroenterology & Hepatology， Minhang Hospital， Fudan University (Central Hospital of Minhang District)， Shanghai 201199， China； 2. Department of Gastroenterology & Hepatology， Zhongshan Hospital， Fudan University， Shanghai 200032， China]
ABSTRACT Objective： To investigate the therapeutic effects， postoperative complications and patient satisfaction of capassisted endoscopic lauromacrogol foam sclerotherapy for bleeding internal hemorrhoids. Methods： Thirteen patients with gradeⅠ～Ⅲ bleeding internal hemorrhoids were admitted and underwent cap-assisted endoscopic lauromacrogol foam sclerotherapy and band ligation when needed. Results： There were 10 patients (76.9%) underwent endoscopic sclerotherapy and 3 patients(23.1%) underwent endoscopic sclerotherapy plus band ligation among 13 patients. After 12 weeks follow-up， 10 patients (76.9%) were cured， and 3 patients (23.1%) were effective. In 10 patients underwent endoscopic sclerotherapy for internal hemorrhoids， 3 patients had mild to moderate pain (30.0%). In 3 patients underwent endoscopic sclerotherapy plus band ligation， two had severe pain and required analgesic (66.7%). None of other serious complication was observed. All patients (100.0%) were satisfied with the procedure. Conclusion： Endoscopic lauromacrogol foam sclerotherapy using cap-assisted gastroscopy operation in retroflexion is flexible， safe， convenient and effective and has value for further clinical evaluation and application.
KEy WORDS bleeding internal hemorrhoid； cap-assisted endoscopic sclerotherapy； band ligation
痔疮是最常见的肛肠疾病，其中出血性内痔治疗棘手，药物治疗效果差，若患者合并重度贫血，手术治疗风险也较大。随着内镜技术的进步，内镜下硬化术治疗内痔[1]得到逐步推广，其能通过使内痔静脉团及周围黏膜组织产生无菌性炎癥而引致内痔静脉团及周围黏膜组织损伤、纤维细胞增生、血栓纤维化，最终达到使内痔静脉团变小、萎缩的目的。但现有的临床数据还有限，患者术后亦可能出现黏膜溃疡、坏死和感染等并发症[2]。痔胶圈套扎治疗[3]是通过阻断内痔的血供、诱发炎性反应，使局部组织纤维化、疤痕形成，其优点在于能准确套扎痔组织及黏膜，但患者术后出血、疼痛、肛门坠胀感、感染、胶圈脱落、发热和溃疡形成等并发症的发生率较高。内镜下硬化术联合胶圈套扎治疗内痔是否更有效、更安全，目前尚不明确。参考国内外文献和国内研究，复旦大学附属闵行医院(上海市闵行区中心医院)消化内科选取13例Ⅰ～Ⅲ度出血性内痔患者为对象，对他们施行透明帽辅助内镜下硬化术治疗，必要时联合胶圈套扎治疗，以观察治疗效果以及患者术中、术后并发症发生情况和满意度，结果显示透明帽辅助经胃镜倒镜操作注射聚桂醇泡沫硬化剂治疗出血性内痔操作方便、安全性高，患者痛苦轻、恢复快，具有进一步研究和临床应用的价值。, 百拇医药(陈颖 陈炜 方青青 张君佩 简佑容 祝子华 田怡 陈世耀)
关键词 出血性内痔 透明帽辅助内镜下硬化术 胶圈套扎
中图分类号：R657.18 文献标志码：B 文章编号：1006-1533(2020)09-0017-06
Clinical observation of the cap-assisted endoscopic lauromacrogol foam sclerotherapy in bleeding internal hemorrhoids
CHEN Ying1*， CHEN Wei1， FANG Qingqing1， ZHANG Junpei1， JIAN Yourong1， ZHU Zihua1， TIAN Yi1， CHEN Shiyao1， 2**
[1. Department of Gastroenterology & Hepatology， Minhang Hospital， Fudan University (Central Hospital of Minhang District)， Shanghai 201199， China； 2. Department of Gastroenterology & Hepatology， Zhongshan Hospital， Fudan University， Shanghai 200032， China]
ABSTRACT Objective： To investigate the therapeutic effects， postoperative complications and patient satisfaction of capassisted endoscopic lauromacrogol foam sclerotherapy for bleeding internal hemorrhoids. Methods： Thirteen patients with gradeⅠ～Ⅲ bleeding internal hemorrhoids were admitted and underwent cap-assisted endoscopic lauromacrogol foam sclerotherapy and band ligation when needed. Results： There were 10 patients (76.9%) underwent endoscopic sclerotherapy and 3 patients(23.1%) underwent endoscopic sclerotherapy plus band ligation among 13 patients. After 12 weeks follow-up， 10 patients (76.9%) were cured， and 3 patients (23.1%) were effective. In 10 patients underwent endoscopic sclerotherapy for internal hemorrhoids， 3 patients had mild to moderate pain (30.0%). In 3 patients underwent endoscopic sclerotherapy plus band ligation， two had severe pain and required analgesic (66.7%). None of other serious complication was observed. All patients (100.0%) were satisfied with the procedure. Conclusion： Endoscopic lauromacrogol foam sclerotherapy using cap-assisted gastroscopy operation in retroflexion is flexible， safe， convenient and effective and has value for further clinical evaluation and application.
KEy WORDS bleeding internal hemorrhoid； cap-assisted endoscopic sclerotherapy； band ligation
痔疮是最常见的肛肠疾病，其中出血性内痔治疗棘手，药物治疗效果差，若患者合并重度贫血，手术治疗风险也较大。随着内镜技术的进步，内镜下硬化术治疗内痔[1]得到逐步推广，其能通过使内痔静脉团及周围黏膜组织产生无菌性炎癥而引致内痔静脉团及周围黏膜组织损伤、纤维细胞增生、血栓纤维化，最终达到使内痔静脉团变小、萎缩的目的。但现有的临床数据还有限，患者术后亦可能出现黏膜溃疡、坏死和感染等并发症[2]。痔胶圈套扎治疗[3]是通过阻断内痔的血供、诱发炎性反应，使局部组织纤维化、疤痕形成，其优点在于能准确套扎痔组织及黏膜，但患者术后出血、疼痛、肛门坠胀感、感染、胶圈脱落、发热和溃疡形成等并发症的发生率较高。内镜下硬化术联合胶圈套扎治疗内痔是否更有效、更安全，目前尚不明确。参考国内外文献和国内研究，复旦大学附属闵行医院(上海市闵行区中心医院)消化内科选取13例Ⅰ～Ⅲ度出血性内痔患者为对象，对他们施行透明帽辅助内镜下硬化术治疗，必要时联合胶圈套扎治疗，以观察治疗效果以及患者术中、术后并发症发生情况和满意度，结果显示透明帽辅助经胃镜倒镜操作注射聚桂醇泡沫硬化剂治疗出血性内痔操作方便、安全性高，患者痛苦轻、恢复快，具有进一步研究和临床应用的价值。, 百拇医药(陈颖 陈炜 方青青 张君佩 简佑容 祝子华 田怡 陈世耀)