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中华胃肠内镜电子杂志 ›› 2022, Vol. 09 ›› Issue (02) : 76 -81. doi: 10.3877/cma.j.issn.2095-7157.2022.02.013

论著

参照肛直线的内镜下套扎术治疗Ⅰ-Ⅲ度内痔临床效果研究
李贞娟1, 丁辉1,(), 王艺1, 胡珊珊1, 白阳秋1, 杨惠1, 邝胜利1, 张慧敏1, 徐闪闪1, 李修岭1   
  1. 1. 450003 郑州,河南省人民医院消化内科、郑州大学人民医院、河南大学临床医学院
  • 收稿日期:2022-04-11 出版日期:2022-05-15
  • 通信作者: 丁辉

Clinical effect of endoscopic rubber band ligation with reference to the anorectal line in the treatment of Ⅰ-Ⅲ internal hemorrhoids

Zhenjuan Li1, Hui Ding1,(), Yi Wang1, Shanshan Hu1, Yangqiu Bai1, Hui Yang1, Shengli Kuang1, Huimin Zhang1, Shanshan Xu1, Xiuling Li1   

  1. 1. Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou 450003, China
  • Received:2022-04-11 Published:2022-05-15
  • Corresponding author: Hui Ding
引用本文:

李贞娟, 丁辉, 王艺, 胡珊珊, 白阳秋, 杨惠, 邝胜利, 张慧敏, 徐闪闪, 李修岭. 参照肛直线的内镜下套扎术治疗Ⅰ-Ⅲ度内痔临床效果研究[J]. 中华胃肠内镜电子杂志, 2022, 09(02): 76-81.

Zhenjuan Li, Hui Ding, Yi Wang, Shanshan Hu, Yangqiu Bai, Hui Yang, Shengli Kuang, Huimin Zhang, Shanshan Xu, Xiuling Li. Clinical effect of endoscopic rubber band ligation with reference to the anorectal line in the treatment of Ⅰ-Ⅲ internal hemorrhoids[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(02): 76-81.

目的

观察参照肛直线的内镜下套扎术(ERBL)治疗Ⅰ-Ⅲ度内痔的临床效果。

方法

回顾性分析2020年4月至2020年12月期间,河南省人民医院消化内科收治的67例进行参照肛直线的ERBL治疗并成功随访的Ⅰ-Ⅲ度内痔患者的临床资料,并对其一般资料、临床特点及治疗效果进行分析。

结果

67例患者中,Ⅰ度35例(52.2%)、Ⅱ度15例(22.4%)、Ⅲ度17例(25.4%);出血者35例(52.2%)、脱垂者9例(13.4%)、出血合并脱垂者23例(34.3%)。手术成功率为100%,治疗总体有效率为88.1%(59/67),其中治愈38例(56.7%)、好转21例(31.3%)、复发2例(3.0%)。术后不良事件方面,疼痛23例(34.3%),其中轻度11例(16.4%)、中度8例(11.9%)、重度4例(6.0%),疼痛患者术后用药百分比为17.4%(4/23),均为重度疼痛患者;肛门坠胀37例(55.2%)、尿潴留12例(17.9%)、发热1例(1.5%)。

结论

参照肛直线的ERBL治疗Ⅰ-Ⅲ度内痔操作简单、安全、疗效显著。

Objective

To observe the clinical effect of endoscopic rubber band ligation (ERBL) of internal hemorrhoids with reference to the anorectal line in the treatment of grade Ⅰ-Ⅲ internal hemorrhoids.

Methods

The clinical data of 67 patients with grade Ⅰ-Ⅲ internal hemorrhoids diagnosed in the department of gastroenterology of Henan Provincial People′s Hospital from April 2020 to December 2020 and successfully followed up with ERBL referring to the anorectal line were analyzed retrospectively. Their general data, clinical characteristics and treatment effects were analyzed.

Results

Among the 67 patients, 35 (52.2%) cases were grade I, 15 (22.4%) were grade II and 17 (25.4%) were grade Ⅲ. Bleeding occurred in 35 cases (52.2%). Prolapse occurred in 9 cases (13.4%); Bleeding complicated with prolapse in 23 cases (34.3%). The success rate of operation was 100%. The overall effective rate was 88.1% (59/67), of which 38 cases were cured (56.7%), 21 cases were improved (31.3%), and 2 cases (3.0%) recurred. In terms of postoperative adverse events, the incidence of pain was 34.3%, including 11 cases (16.4%) of mild pain, 8 cases (11.9%) of moderate pain and 4 cases (6.0%) of severe pain. The percentage of postoperative medication in patients with pain was 17.4% (4/23), which were all patients with severe pain. Anal swelling occurred in 37 cases (55.2%), urinary retention in 12 cases (17.9%), fever in 1 case (1.5%).

Conclusion

ERBL for internal hemorrhoids with reference to anorectal line is simple, safe and effective in the treatment of grade I-Ⅲ internal hemorrhoids.

图1 参照肛直线内痔ERBL过程注:A:套扎前肛门处可见内痔痔核脱出;B:进镜时正镜观察肛门处痔核,表面RC(+);C:直肠反转观察肛门处可见多枚痔核,其中一枚最明显,并可清晰观察到肛直线(绿线)、齿状线(红线)等解剖结构;D:于肛直线上套扎后,可见套扎后套扎环位于肛直线上方,痔核得到一定程度的提拉;E:正镜观察肛门处套扎环;F:套扎后肛门处脱垂痔核得到提拉
表1 患者术前临床表现及Goligher分类情况[n( %)]
表2 术后不良事件发生情况[n( %)]
表3 内痔ERBL术后效果分析[n( %)]
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