| Background:Internal hemorrhoids are the most common type of hemorrhoids,which seriously affect the quality life of patients.Common clinical symptoms of internal hemorrhoids include bleeding,prolapse,itching,pain,ect,and some unhealthy lifestyles such as intake of alcohol,spicy diet,low-fiber diet,will also increase the incidence of hemorrhoids.The clinical treatment options for internal hemorrhoids mainly include conservative treatment,minimally invasive treatment and surgical treatment,each of which has its own advantages and disadvantages.At present,with the continuous development of endoscopic treatment for internal hemorrhoids,endoscopic rubber band ligation and endoscopic sclerotherapy have become quite common.The last decade has saw grate progresses in the development of less traumatic surgery.However,the advantages and disadvantages of these three approaches is yet an unanswered question.Objective:To compare the complications and effects of endoscopic rubber band ligation,endoscopic sclerotherapy,and procedure for prolapse and hemorrhoids for grade Ⅱ-Ⅲ internal hemorrhoids,the aim of this study is to conduct a clinical observation of these thee operational methods and to provide reference for future clinical treatment of internal hemorrhoids.Methods:Patients with endoscopic rubber band ligation and endoscopic sclerotherapy injection and PPH for grade Ⅱ-Ⅲ internal hemorrhoids who were treated in Henan Provincial People’s Hospital from January2020 to August 2021 were collected by retrospective analysis method,and the pain levels within 24 hours and the 7th day after operation were compared among the three groups.The pain levels were expressed by visual analogue scale(VAS).Postoperative complications including pain,bleeding,anal swelling,fever,urinary retention,clinical effects and patient satisfaction 6 months after operation were compared among the three groups.Data analysis was processed using SPSS 21 software.Results:A total of 140 patients were enrolled,including 90 cases with endoscopic rubber band ligation,24 cases with endoscopic sclerotherapy injection,and 26 cases with PPH.Postoperative complications:24patients occurred pain in endoscopic rubber band ligation within 24 hours after operation,and 5 patients occurred pain in endoscopic sclerotherapy injection,and 17 patients occurred pain in the PPH,and the incidence of pain in three groups was respectively 26.7%(24/90),20.8%(5/24),65.4%(17/26)in the postoperative 24 hours,and the pain visual simulation score(VAS)of the three groups were 3.00(3.00,4.00),3.00(2.50,3.50),4.00(3.00,5.00).Six patients in endoscopic rubber band ligation,2 patients in the endoscopic sclerotherapy injection,and 5 patients in the PPH occurred pain in the 7th day after operation,and the incidence of pain in three groups was 6.7%(6/90),8.3%(2/24),19.2%(5/26)in the 7th day after operation,respectively.The pain visual simulation score(VAS)in three groups was 0.00(0.00,0.75),0.00(0.00,0.75),0.00(0.00,1.00),respectively.There was a statistical difference in the number of pain cases and pain visual simulation score of the three groups within 24 hours after operation,and there was no significant statistical difference in the number of pain cases and pain visual simulation score in the7 th day after operation.Bleeding occurred in three groups within 7 days after operation: 13 patients in the endoscopic rubber band ligation group,4 patients in the endoscopic sclerotherapy group,and 10 patients in the PPH group occurred defecation bleeding.The incidence of bleeding in the three groups within 7 days after operation was 14.4%(13/90),16.7%(4/24),38.5%(10/26),respectively.There was a significantly difference among the three groups.The anal swelling occurred in three groups within 7 days after operation:35 patients in the endoscopic rubber band ligation group,11 patients in the endoscopic sclerotherapy group,and 18 patients in the PPH group occurred anal swelling.and the incidence of postoperative anal swelling in the three groups was 38.9%(35/90),45.8%(11/24),69.2%(18/26),respectively,with a statistically significant difference.Fever in the three groups within 7 days after operation: 1 patient in the endoscopic rubber band ligation group,1 patient in the endoscopic sclerotherapy group,and 2 patients in the PPH group occurred fever,and the incidence of postoperative fever was 1.1%(1/90),4.2%(1/24),and 7.7%(2/26)in the three groups,respectively.There was no significantly difference among the three groups.The occurrence of postoperative urinary retention in three groups: 1 patient in the endoscopic rubber band ligation group,no patient in the endoscopic sclerotherapy group,and 1 patient in the PPH group occurred urinary retention,and the incidence of postoperative urinary retention in the three groups was 1.1%(1/90),0%(0/24),3.9%(1/26),respectively.and there was no significant statistical difference.Clinical effects in the postoperative 6 months of three groups : 47 patients in the endoscopic rubber band ligation group were clinically cured,and 31 patients were clinically effective,and 12 patients were ineffective.11 patients in the endoscopic sclerotherapy group were clinically cured,and 9 patients were clinically effective,and 4 patients were ineffective.12 patients in the PPH group were clinically cured,and 9 patients were clinically effective,and 5 patients were ineffective.The total effective rate after operation in the three groups was 86.7%(78/90),83.3%(20/24),80.8%(21/26),respectively.Ineffective patients of three groups were analyzed separately,and 4 cases were from II degree internal hemorrhoids and 8 cases were from III degree internal hemorrhoids in the endoscopic rubber band ligation group,and the results showed that there was a statistically significant difference between II degree and III degree internal hemorrhoids for the clinical effects of patients in endoscopic rubber band ligation group.Two cases were from II degree internal hemorrhoids and 2 cases were from III degree internal hemorrhoids in the endoscopic sclerotherapy group,and the results showed that there was no significant difference between II degree and III degree internal hemorrhoids for the clinical effects of patients in endoscopic sclerotherapy group.Two cases were from II degree internal hemorrhoids and 3 cases were from III degree internal hemorrhoids in the PPH group,and there was no significant difference between II degree and III degree internal hemorrhoids for the clinical effects of patients in PPH group.The satisfaction rate of the three groups in the six months after operation were 86.7%(78/90),83.3%(20/24),and 76.9%(20/26),respectively,and there was no significant difference in the satisfaction of the three groups.Conclusion:1.There was commendable clinical effects of the three groups for grade Ⅱ-Ⅲ internal hemorrhoids.Complication rates after ERBL and EIS are comparable.However,ERBL has a lower incidence of postoperative complications than PPH.2.Treatment of internal hemorrhoids under gastrointestinal endoscopy has the advantages of flexible operation and less postoperative complications,saving related medical costs,and it is a new treatment option for mild to moderate internal hemorrhoids. |
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