胡恩伟,李玉锋,路旭,陈航

• 1:北京市昌平区中医医院肛肠泌尿科

摘要(Abstract)：

目的 评估聚多卡醇注射联合自动痔疮套扎术（ruiyun procedure for hemorrhoids,RPH）治疗Ⅲ～Ⅳ期内痔的临床效果，并分析其对患者术后疼痛评分及长期预后的影响，从而为临床决策提供科学依据。方法 采取回顾性研究分析，选取2021年3月—2023年3月收治的100例Ⅲ～Ⅳ期内痔患者。按照不同治疗方法分为对照组（n=58例，RPH术治疗）与观察组（n=42例，RPH术联合聚多卡醇注射治疗），比较2组患者的临床疗效、视觉模拟法（Visual Analogue Scale, VAS）评分、肛门症状（坠胀、出血、瘙痒）、并发症发生率及复发率等。结果 观察组的治疗总有效率高于对照组（90.48%vs. 72.41%, P<0.05）;2组术后的VAS评分均降低，且观察组患者在术后1、3、7 d的VAS评分均低于对照组;2组患者术后7 d的肛门坠胀、出血、瘙痒评分较术前均降低，且观察组均低于对照组（P<0.05）;观察组的并发症发生率及复发率均低于对照组（P<0.05）。结论 聚多卡醇注射联合RPH术对Ⅲ～Ⅳ期内痔患者的治疗效果显著，可提高疗效，降低疼痛程度，缓解肛门症状，且并发症少、复发率低，值得临床推广应用。

关键词(KeyWords)： 聚多卡醇;自动痔疮套扎术;Ⅲ～Ⅳ期内痔;疼痛指标;预后

Abstract:

Keywords:

基金项目(Foundation): 北京市科技计划项目(编号:Z211100001718116)

作者(Author): 胡恩伟,李玉锋,路旭,陈航

参考文献(References)：

• [1]智从从，李雪，程一乘，等.痔中西医结合诊疗指南（2025版）[J].中国全科医学，2025,28(26):3217-3228.ZHI Congcong, LI Xue, CHENG Yicheng, et al.Guidelines for integrated traditional Chinese and western medicine diagnosis and treatment of hemorrhoids(2025edition)[J]. Chinese General Practice,2025,28(26):3217-3228.
• [2]陈步强，常忠生，曹林峰，等. RPH在Ⅲ、Ⅳ期内痔合并低位肛周脓肿手术中的应用[J].中国中西医结合外科杂志，2020,26(2):328-332.CHEN Buqiang,CHANG Zhongsheng,CAO Linfeng.Application of RPH in the treatment of low perianal abscess combined withⅢ，Ⅳinternal hemorrhoids[J].Chinese Journal of Surgery of Integrated Traditional and Western Medicine,2020,26(2):328-332.
• [3]倪永忠，惠小苏，周守芝，等.自动痔疮套扎术对Ⅲ、Ⅳ度混合痔患者肛门功能和机体应激的影响及手术效果的影响因素分析[J].现代生物医学进展，2023,23(3):565-569,514.NI Yongzhong,HUI Xiaosu,ZHOU Shouzhi,et al.Effect of Ruiyun procedure for hemorrhoid on anal function and body stress in patients with gradeⅢandⅣmixed hemorrhoids and analysis of influencing factors of surgical effect[J]. Progress in Modern Biomedicine,2023,23(3):565-569,514.
• [4] DEKKER L,HAN-GEURTS I J M,R?RVIK H D,et al. Rubber band ligation versus haemorrhoidectomy for the treatment of gradeⅡ-Ⅲhaemorrhoids:A systematic review and Meta-analysis of randomised controlled trials[J].Tech Coloproctol,2021,25(6):663-674.
• [5]徐明，徐振荣，邱慧，等. 3%聚多卡醇泡沫硬化剂注射治疗Goligher-Ⅱ/Ⅲ级内痔的效果及安全性[J].中国现代普通外科进展，2023,26(11):906-909.XU Ming,XU Zhenrong,QIU Hui,et al. Effectiveness and safety of 3%polidocanol foam sclerotherapy for hemorrhoidal disease grades Goligher-Ⅱ/Ⅲ[J]. Chinese Journal of Current Advances in General Surgery,2023,26(11):906-909.
• [6] LISI G,GENTILESCHI P,SPOLETINI D,et al.Sclerotherapy forⅢ-andⅣ-degree hemorrhoids:Results of a prospective study[J]. Front Surg,2022,9:978574.
• [7]中国中西医结合学会大肠肛门病专业委员会．中国痔病诊疗指南（2020）[J].结直肠肛门外科，2020,26(5):519-533.The Coloproctology Society of Chinese Association of Integrative Medicine. Guidelines for the diagnosis and treatment of hemorrhoids in China(2020)[J]. Journal of Colorectal&Anal Surgery,2020,26(5):519-533.
• [8]世界中医药学会联合会肛肠病专业委员会.痔的围手术期管理专家共识[J].中国微创外科杂志，2023,23(6):401-408.Professional Committee of Colorectal Diseases of the World Federation of Chinese Medicine Societies. Expert consensus on perioperative management of hemorrhoids[J].Chinese Journal of Minimally Invasive Surgery,2023,23(6):401-408.
• [9]丁亚鹏，肖新凯，张君.祛瘀消肿汤内服联合中药熏洗对混合痔术后疼痛及创面愈合的影响[J].中南医学科学杂志，2025,53(4):687-689.DING Yapeng,XIAO Xinkai,ZHANG Jun. Effect of oral Quyu Xiaozhong Decoction combined with herbal fumigation on postoperative pain and wound healing in mixed hemorrhoids[J]. Medical Science Journal of Central South China,2025,53(4):687-689.
• [10]陈希琳，陈朝文，段宏岩，等.痔诊疗日间手术专家共识（2020年版）[J].实用临床医药杂志，2020,24(10):1-8.CHEN Xilin,CHEN Chaowen,DUAN Hongyan,et al.Consensus of experts on daytime operation for hemorrhoid diagnosis and treatment(2020 Edition)[J]. Journal of Clinical Medicine in Practice,2020,24(10):1-8.
• [11]常树勋，王宝婷，孙艳军，等.解毒活血汤联合普济痔疮栓对中重度痔疮术后患者的疗效[J].西北药学杂志，2023,38(4):127-131.CHANG Shuxun,WANG Baoting,SUN Yanjun,et al.Efficacy of Jiedu Huoxue Decoction combined with Puji Hemorrhoid Suppository in the treatment of postoperative patients with moderate to severe hemorrhoids[J]. Northwest Pharmaceutical Journal,2023,38(4):127-131.
• [12]谢长访，赵帅，熊英，等.内镜下套扎联合硬化剂注射治疗痔疮术后不良预后的影响因素分析[J].临床消化病杂志，2024,36(4):235-238.XIE Changfang,ZHAO Shuai,XIONG Ying,et al.Analysis of influencing factors of poor prognosis of patients with hemorrhoids treated by endoscopic ligation combined with sclerotherapy[J]. Chinese Journal of Clinical Gastroenterology,2024,36(4):235-238.
• [13] SAMESHIMA T,NIWA K,ETO T,et al. Treatment result of the mucopexy-recto anal lifting method for hemorrhoids in comparison with ligation and excision,and aluminum potassium sulfate and tannic acid sclerotherapy[J]. J Anus Rectum Colon,2022,6(3):143-149.
• [14]张瑶洁，张飞宇，沈峰，等.内镜下泡沫硬化剂治疗Ⅰ~Ⅲ度内痔的随机对照试验[J].中国内镜杂志，2023,29(7):48-55.ZHANG Yaojie,ZHANG Feiyu,SHEN Feng,et al.Efficacy of endoscopic foam sclerosant versus liquid sclerotherapy for degreeⅠ—Ⅲinternal hemorrhoids:A randomized controlled trail[J]. China Journal of Endoscopy,2023,29(7):48-55.
• [15] KOBAYASHI K,FURUMOTO Y,AKUTSU D,et al.Endoscopic detachable snare ligation improves the treatment for colonic diverticular hemorrhage[J]. Digestion,2020,101(2):208-216.
• [16]蔡筱颖，沈一，龚梦娇，等.对比聚桂醇泡沫硬化剂与聚桂醇注射液在内痔患者中的疗效及术后并发症[J].昆明医科大学学报，2022,43(12):137-141.CAI Xiaoying,SHEN Yi,GONG Mengjiao,et al.Comparison of efficacy and postoperative complications of lauromacrogol foam sclerosant and Lauromacrogol Injection in patients with internal hemorrhoids[J]. Journal of Kunming Medical University,2022,43(12):137-141.
• [17]刘正娟，徐春晓，李婉君.内镜下肛直线上套扎术与硬化剂注射对Ⅱ~Ⅲ度内痔的疗效比较[J].川北医学院学报，2024,39(7):965-968.LIU Zhengjuan,XU Chunxiao,LI Wanjun. Comparison of influence of anorectal line ligation and endoscopic injection sclerotherapy on efficacy in patients withⅡ—Ⅲinternal hemorrhoids[J]. Journal of North Sichuan Medical College,2024,39(7):965-968.
• [18] GANZ R A. The evaluation and treatment of hemorrhoids:A guide for the gastroenterologist[J]. Clin Gastroenterol Hepatol,2013,11(6):593-603.
• [19]钟婷，庞文璟，王磊，等.内镜下微创治疗内痔53例疗效分析[J].国际消化病杂志，2022,42(6):378-382,392.ZHONG Ting,PANG Wenjing,WANG Lei,et al.Clinical analysis of 53 cases of internal hemorrhoids treated with minimally invasive endoscopy[J]. International Journal of Digestive Diseases,2022,42(6):378-382,392.
• [20]马涛，艾娟. RPH并聚桂醇注射术治疗重度痔疮的临床效果研究[J].中国保健营养，2018,28(6):49-50.MA Tao,AI Juan.Clinical effect of RPH combined with cinnamyl alcohol injection in the treatment of severe hemorrhoids[J]. China Health Care&Nutrition,2018,28(6):49-50.
• [21] PATA F,BRACCHITTA L M,D’AMBROSIO G,et al.Sclerobanding(combined rubber band ligation with 3%polidocanol foam sclerotherapy)for the treatment of secondand third-degree hemorrhoidal disease:Feasibility and shortterm outcomes[J]. J Clin Med,2021,11(1):218.