【摘要】 目的 探讨透明帽辅助内镜下硬化术(CAES)治疗痔疮的疗效及对患者肛肠动力学、血清炎症因子的影响。方法 回顾性选取2020年1月至2022年12月在青岛市第八人民医院接受手术治疗的痔疮患者90例作为研究对象，根据术式不同分为外剥内扎术(MMH)组和CAES组，各45例。MMH组采用传统MMH治疗，CAES组采用CAES治疗。比较两组的手术相关指标(手术时间、术中出血量、术后24 h疼痛评分及创面愈合时间),评价两组的治疗效果、肛肠动力学[直肠静息压(RRP)、肛管最大收缩压(MSP)和直肠最大耐受容量(MTV)]、血清炎症因子等，并进行统计比较。结果 CAES组手术时间、术中出血量、术后24 h疼痛评分及创面愈合时间分别为(25.15±5.69) min、(41.45±8.12) mL、(2.32±0.61)分、(10.63±2.14) d,均明显低于MMH组[(44.01±11.74) min、(77.94±16.70) mL、(3.75±0.78)分、(17.24±2.82) d],差异均有统计学意义(P<0.05)。CAES组治疗总有效率为93.33%,显著高于MMH组(73.33%),差异有统计学意义(P<0.05)。术后1个月，CAES组RRP为(6.93±1.24) mmHg,明显低于MMH组[(9.01±1.32) mmHg],MSP和MTV分别为(122.23±12.24) mmHg、(195.38±25.71) mL,均显著高于MMH组[(114.68±11.07) mmHg、(167.04±31.53) mL],差异均有统计学意义(P<0.05)。术后1个月，CAES组血清CRP、IL-6和TNF-α水平分别为(9.02±1.47) mg/L、(8.27±2.53) ng/L、(3.73±0.90) ng/L,均显著低于MMH组[(20.84±3.62) mg/L、(15.13±3.27) ng/L、(5.21±1.19) ng/L],差异均有统计学意义(P<0.05)。CAES组并发症总发生率为6.67%,明显低于MMH组(35.56%),差异有统计学意义(P<0.05)。结论 CAES可提高痔疮的临床疗效，降低机体炎症反应，促进肛肠动力学恢复，且创伤小、疼痛轻、并发症少，值得推荐。更多还原

【Abstract】 Objective To investigate the effect of transparent cap-assisted endoscopic sclerotherapy(CAES) on hemorrhoids and its influence on anorectal dynamics and serum inflammatory factors. Methods A retrospective study was conducted on 90 patients with hemorrhoids who underwent surgical treatment at The Eighth People’s Hospital of Qingdao from January 2020 to December 2022. According to different surgical procedures, they were divided into the external dissection and internal ligation(MMH) group and the CAES group, with 45 cases in each group. The MMH group received traditional MMH treatment, while the CAES group received CAES treatment. The surgical related indicators(surgical time, intraoperative bleeding, postoperative 24-hour pain score, and wound healing time) of two groups were compared. The therapeutic effect, anorectal dynamics[rectal resting pressure(RRP), anal maximum systolic pressure(MSP), the rectum tolerates maximum volume(MTV)] and serum inflammatory factors of the two groups were evaluated and compared. Results The operation time, intraoperative bleeding, 24 h postoperative pain score and wound healing time in CAES group were(25.15±5.69) min,(41.45±8.12) mL,(2.32±0.61) min,(10.63±2.14) d, which were significantly lower than those in MMH group[(44.01±11.74) min,(77.94±16.70) mL,(3.75±0.78) min,(17.24±2.82) d], the differences were statistically significant(P<0.05). The total effective rate of CAES group was 93.33%, which was significantly higher than that of MMH group(73.33%), the difference was statistically significant(P<0.05). At 1 month after operation, the RRP of the CAES group was(6.93±1.24) mmHg, which was significantly lower than that of the MMH group [(9.01±1.32) mmHg], the MSP and MTV were(122.23±12.24) mmHg and(195.38±25.71) mL, respectively, which were significantly higher than those of the MMH group [(114.68±11.07) mmHg and(167.04±31.53) mL], the differences were statistically significant(P<0.05). At 1 month after operation, the levels of serum CRP, IL-6, and TNF-α in the CAES group were(9.02±1.47) mg/L,(8.27±2.53) ng/L, and(3.73±0.90) ng/L, respectively, which were significantly lower than those in the MMH group [(20.84±3.62) mg/L,(15.13±3.27) ng/L, and(5.21±1.19) ng/L], the differences were statistically significant(P<0.05). The total incidence of complications was 6.67%, which was significantly lower than that of MMH group(35.56%), the difference was statistically significant(P<0.05). Conclusion CAES can improve the clinical efficacy of hemorrhoids, reduce the inflammatory reaction of the body, promote the recovery of anorectal dynamics, and has less trauma, less pain, and fewer complications, which is worth recommending.更多还原