内痔内镜下微创治疗疗效及复发率的单中心大样本回顾性观察

Single‑center large sample retrospective observation of the efficacy and recurrence rate of minimally invasive endoscopic treatment for internal hemorrhoids

摘要:

目的 评估内痔内镜下微创治疗的临床价值。方法 2018年12月至2022年6月，南方医科大学深圳医院内镜中心行内镜下微创治疗的1 027例Ⅰ～Ⅲ度内痔病例纳入回顾性分析，其中接受内镜下硬化剂注射治疗者552例、接受内镜下套扎治疗者404例、接受内镜下套扎联合硬化剂注射治疗者71例，主要观察总体以及不同治疗方法下的治疗有效率和复发率。结果 内镜下内痔微创治疗总体有效率为94.5%（971/1 027）：内镜下硬化剂注射治疗552例，其中Ⅰ度、Ⅱ度和Ⅲ度内痔分别为251例（45.5%）、259例（46.9%）和42例（7.6%），总体治疗有效率为92.9%（513/552），其中Ⅰ度、Ⅱ度和Ⅲ度内痔的治疗有效率分别为94.4%（237/251）、91.9%（238/259）和90.5%（38/42）；内镜下套扎治疗404例，其中Ⅰ度、Ⅱ度和Ⅲ度内痔分别为21例（5.2%）、194例（48.0%）和189例（46.8%），总体治疗有效率为96.0%（388/404），其中Ⅰ度、Ⅱ度和Ⅲ度内痔的治疗有效率分别为100.0%（21/21）、98.5%（191/194）和93.1%（176/189）；内镜下套扎联合硬化剂注射治疗71例，其中Ⅰ度、Ⅱ度和Ⅲ度内痔分别为0例（0.0%）、13例（18.3%）和58例（81.7%），总体治疗有效率为98.6%（70/71），其中Ⅱ度和Ⅲ度内痔的治疗有效率分别为100.0%（13/13）和98.3%（57/58）。首次内镜下治疗后随访3～43个月，内镜下内痔微创治疗总体复发率为11.2%（109/971）：513例内镜下硬化剂注射治疗有效者中，74例（14.4%）复发，其中Ⅰ度、Ⅱ度和Ⅲ度内痔的复发率分别为4.6%（11/237）、21.4%（51/238）和31.6%（12/38）；388例内镜下套扎治疗有效者中，29例（7.5%）复发，其中Ⅰ度、Ⅱ度和Ⅲ度内痔的复发率分别为0.0%（0/21）、5.8%（11/191）和10.2%（18/176）；70例内镜下套扎联合硬化剂注射治疗有效者中，6例（8.6%）复发，其中Ⅱ度和Ⅲ度内痔的复发率分别为7.7%（1/13）和8.8%（5/57）。结论 内痔行内镜下微创治疗总体疗效好、复发率低，具有较好的临床应用价值。对于Ⅰ度内痔，选择内镜下硬化剂注射治疗即可保证疗效，临床更多选择该方法；对于Ⅱ度内痔，建议选择内镜下套扎治疗，疗效满意且复发率低；而对于Ⅲ度内痔，建议行套扎联合硬化注射治疗，以保证疗效并减少复发率。

Abstract:

Objective To investigate the clinical value of minimally invasive endoscopic treatment for internal hemorrhoids. Methods A total of 1 027 cases of grade Ⅰ to Ⅲ internal hemorrhoids who underwent minimally invasive endoscopic treatment in the Endoscopy Center of Shenzhen Hospital of Southern Medical University From December 2018 to June 2022 were included in the retrospective analysis, including 552 cases of endoscopic sclerotherapy, 404 of endoscopic ligation, and 71 of endoscopic ligation combined with sclerotherapy. The effective rate and recurrence rate were observed in general and different treatment methods. Results The overall effective rate of minimally invasive treatment of internal hemorrhoids under endoscopy was 94.5% (971/1 027). Among the 552 cases treated with endoscopic sclerotherapy, 251 cases (45.5%) were grade Ⅰ, 259 (46.9%) grade Ⅱ and 42 (7.6%) grade Ⅲ. The overall effective rate was 92.9% (513/552), and the effective rates of grade Ⅰ, Ⅱ and Ⅲ hemorrhoids were 94.4% (237/251), 91.9% (238/259) and 90.5% (38/42), respectively. For 404 cases of endoscopic ligation, there were 21 cases (5.2%), 194 cases (48.0%) and 189 cases (46.8%) of internal hemorrhoids in grade Ⅰ, Ⅱ and Ⅲ, respectively. The overall treatment effective rate was 96.0% (388/404), and the effective rates of grade I, Ⅱ and Ⅲ hemorrhoids were 100.0% (21/21), 98.5% (191/194) and 93.1% (176/189), respectively. Fore 71 cases treated with endoscopic ligation combined with sclerosing agent injection, there were 0 cases (0.0%), 13 cases (18.3%) and 58 cases (81.7%) of internal hemorrhoids in grade Ⅰ, Ⅱ and Ⅲ, respectively. The overall treatment effective rate was 98.6% (70/71). The effective rates of grade Ⅱ and Ⅲ hemorrhoids were 100.0% (13/13) and 98.3% (57/58), respectively. The overall recurrence rate of minimally invasive treatment for internal hemorrhoids under endoscopy was 11.2% (109/971) at a follow-up of 3 to 43 months after the first endoscopic treatment. Among 513 patients who were effectively treated with endoscopic sclerotherapy, 74 (14.4%) recurred, and the recurrence rates of grade Ⅰ, Ⅱ and Ⅲ hemorrhoids were 4.6% (11/237), 21.4% (51/238) and 31.6% (12/38), respectively. Among 388 patients with effective endoscopic ligation, 29 cases (7.5%) relapsed, and the recurrence rates of grade Ⅰ, Ⅱ and Ⅲ hemorrhoids were 0.0% (0/21), 5.8% (11/191) and 10.2% (18/176), respectively. Among the 70 patients who were effectively treated with endoscopic ligation combined with sclerotherapy, 6 cases (8.6%) relapsed, and the recurrence rates of grade Ⅱ and Ⅲ hemorrhoids were 7.7% (1/13) and 8.8% (5/57), respectively. Conclusion Endoscopic minimally invasive treatment for internal hemorrhoids has good overall effect and low recurrence rate, with good clinical application value. For grade Ⅰ internal hemorrhoids, endoscopic sclerosing agent injection can guarantee the curative effect, and this method is more commonly used in clinic. For grade Ⅱ hemorrhoids, endoscopic ligation is recommended, with satisfactory efficacy and low recurrence rate. For grade Ⅲ internal hemorrhoids, ligature combined with sclerotherapy injection is recommended to ensure the efficacy and reduce the recurrence rate.