不同麻醉方法下芍倍注射液治疗内痔的疗效比较

黎小平 罗竞勇 刘超

[摘要] 目的 比较Ⅱ期内痔分别在局麻和骶麻下行芍倍注射液术的治疗效果。 方法 选取2016年10月～2018年12月我科收治的124例Ⅱ期内痔患者为研究对象，随机分为局麻组（62例）和骶麻组（62例），分别观察痔注射后痔核萎缩变化情况以及对比两种麻醉方法下临床症状如肛门坠胀、出血、脱出、肛门潮湿改善方面的情况。 结果 治疗后2 d、4 d两组痔核均有不同程度的萎缩，无明显差异（P>0.05），在7 d骶麻组的萎缩程度明显高于局麻组（P<0.05）。两组治疗Ⅱ期内痔的肛门潮湿感无显著性差异（P>0.05），但骶麻组在术后肛门坠胀感、出血及痔核脱出明显优于局麻组（P<0.05）。 结论 骶麻下行芍倍注射液治疗Ⅱ期内痔效果更好。

[关键词] 骶麻;局麻;芍倍注射液;内痔

[中图分类号] R657.18          [文献标识码] B          [文章编号] 1673-9701（2020）15-0059-03

A comparison of therapeutic effect of Shaobei injection on internal hemorrhoids under different anesthesia

LI Xiaoping   LUO Jingyong   LIU Chao   LI Manman   FANG Qingshan

Department of Gastroenterology， Nanhai Hospital Affiliated to Southern Medical University， Foshan   528244， China

[Abstract] Objective To compare the therapeutic effects of Shaobei injection under local anesthesia and sacral anesthesia respectively on stage Ⅱ internal hemorrhoids. Methods 124 patients with stage Ⅱ internal hemorrhoids admitted to our department from October 2016 to December 2018 were selected as research subjects and randomly divided into local anesthesia group（n=62） and sacral anesthesia group（n=62）. The changes of hemorrhoid atrophy after hemorrhoid injection were observed and the clinical symptoms such as anal falling bulge， hemorrhage， prolapse and improvement of anus damp were compared under the two kinds of anesthesia. Results Hemorrhoids in the two groups shrank to different degrees on the 2nd and 4th day after treatment， with no significant difference（P>0.05）. The degree of atrophy in the sacral anesthesia group on the 7th day was significantly higher than that in the local anesthesia group（P<0.05）. There was no significant difference between the two groups in the sensation of the anus damp in the treatment of stage Ⅱ internal hemorrhoids（P>0.05）， but the sensation of anal falling bulge and defecation， hemorrhage and prolapse of hemorrhoids in the sacral anesthesia group were significantly better than those in the local anesthesia group（P<0.05）. Conclusion Shaobei injection under sacral anesthesia is more effective in the treatment of stage Ⅱ internal hemorrhoids.

[Key words] Sacral anesthesia; Local anesthesia; Shaobei injection; Internal hemorrhoids

內痔是由肛垫的支持结构、静脉丛及动静脉吻合支发生病理性改变、导致肛垫充血增生肥大移位而形成，位于在齿线以上，临床上以便血和肿物突出为主要症状，部分患者可伴有肛门的坠胀感及肛门潮湿感。根据痔脱垂情况分为四度：I度，便血无痔脱垂;Ⅱ度，排便时痔脱出但可自行还纳，可伴有出血;Ⅲ度，排便时痔脱出，不能自行回纳需用手才能还纳、可伴有出血。Ⅳ度痔脱出不能还纳或还纳后马上再脱出，可伴有出血[1]。

关于内痔的发病机制目前尚未完全阐明，主要有下列学说如肛垫下移、静脉曲张、感染学说、肛管高张力学说等[2]。其中以肛垫下移和静脉曲张学说为时下主流。

内痔的治疗：I度主要给予药物或痔疮栓以及清淡饮食、保持大便通畅等，Ⅱ度的治疗主要采取注射或套扎疗法（RPH）[3]，Ⅲ度、Ⅳ度主要采取手术如PPH（吻合器痔上黏膜环切术）、TST（开环式微创痔上黏膜切除吻合术）及M-M（外剥内扎术）等[4]。