内镜下负压套扎术对Ⅱ、Ⅲ度痔疮患者肛肠动力学、炎症反应及免疫功能的影响

摘要 目的：探讨内镜下负压套扎术对Ⅱ、Ⅲ度痔疮患者肛肠动力学、炎症反应及免疫功能的影响。方法：选择2021年3月到2023年3月期间邯郸市中心医院收治的120例Ⅱ、Ⅲ度痔疮患者。按照手术方式的不同将患者分为A组（传统外剥内扎术，n=58）和B组（内镜下负压套扎术，n=62）。对比两组围术期指标、肛肠动力学、炎症反应及免疫功能变化情况，同时观察两组并发症发生率。结果：B组术中出血量少于A组，手术时间、首次排便时间、住院时间短于A组，术后24 h疼痛视觉模拟量表（VAS）评分低于A组（P<0.05）。两组术后3个月直肠最大耐受量、直肠感觉阈值、肛管静息压、肛管最大收缩压下降，且B组低于A组（P<0.05）。两组术后3 d白介素-6（IL-6）、白介素-8（IL-8）、白介素-12（IL-12）、C反应蛋白（CRP）升高，但B组低于A组（P<0.05）。两组术后3 d CD8⁺升高，但B组低于A组，CD3⁺、CD4⁺、CD4⁺/CD8⁺下降，但B组高于A组（P<0.05）。B组的并发症发生率低于A组（P<0.05）。结论：与传统外剥内扎术治疗相比，内镜下负压套扎术用于Ⅱ、Ⅲ度痔疮，具有创伤小，术后恢复快的优势，同时还可促进机体肛肠动力学恢复，减轻炎症反应和免疫抑制，降低术后并发症发生率。

Effect of Endoscopic Negative Pressure Ligation on Anorectal Dynamics, Inflammatory Response and Immune Function in Patients with II and III Degree Hemorrhoids

ABSTRACT Objective: To investigate the effect of endoscopic negative pressure ligation on anorectal dynamics, inflammatory response and immune function in patients with grade II and III hemorrhoids. Methods: 120 patients with grade II and III hemorrhoids who were admitted to Handan Central Hospital from March 2021 to March 2023 were selected. Patients were divided into group A (traditional external stripping and internal ligation, n=58) and group B (endoscopic negative pressure ligation, n=62) according to the different surgical methods. The perioperative indexes, anorectal dynamics, inflammatory response and immune function were compared between two groups, and the incidence of complications was observed. Results: The intraoperative blood loss in group B was less than that in group A, the operation time, first defecation time and hospitalization time were shorter than those in group A, and the pain visual analogue scale (VAS) score at 24 h after operation was lower than that in group A(P<0.05). The maximum rectal tolerance, rectal sensory threshold, anal resting pressure and anal maximum systolic pressure decreased in two groups at 3 months after operation, and those in group B were lower than in group A(P<0.05). The levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-12 (IL-12) and C-reactive protein (CRP) in two groups increased at 3 days after operation, but those in group B were lower than those in group A (P<0.05). CD8⁺ increased in two groups at 3 days after operation, but group B was lower than group A, CD3⁺, CD4⁺, CD4⁺/CD8⁺ decreased, but group B was higher than group A (P<0.05). The incidence of complications in group B was lower than that in group A (P<0.05). Conclusion: Compare with traditional external dissection and internal ligation, endoscopic negative pressure ligation for II and III degree hemorrhoids has the advantages of less trauma and faster postoperative recovery, and it can also promote the recovery of anorectal dynamics, reduce inflammatory response and immunosuppression, and reduce the incidence of postoperative complications.