Batra P, O'Connor A, Walmsley J, Baraza W, Sharma A
Manchester University NHS Foundation Trust, UK.
The University of Manchester, UK.
Ann R Coll Surg Engl. 2025 Jan;107(1):25-28. doi: 10.1308/rcsann.2023.0097. Epub 2024 Jan 4.
Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients.
A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution.
A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported.
Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.
有症状的痔（SH）是一种常见病症；然而，包括橡皮圈套扎术在内的传统门诊治疗方法，对于正在接受抗凝治疗的患者是禁忌的。注射硬化疗法（IST）已被提议作为这些患者的一种治疗选择。
在一个与三级心胸外科科室相邻的结直肠外科进行了病例记录的回顾性研究。确定了2014年4月1日至2021年11月30日期间接受IST治疗SH的患者。由于这些患者发生血栓栓塞的风险很高，除了两名需要进行替代手术的患者外，抗凝治疗并未停止。主要结局是症状缓解，定义为至少六个月内无患者报告出血。次要结局是患者报告的并发症、IST手术次数以及为实现症状缓解而进行的其他手术次数。
共确定了20例患者，中位年龄为64岁（范围35 - 86岁，男性14例），接受了32次IST治疗。在继续抗凝治疗的同时，18例（90%）患者通过IST实现了症状缓解，2例（10%）患者需要进行替代干预。10例（50%）患者仅需进行一次IST手术，3例（15%）患者需要进行两次手术。其余5例（25%）患者需要进行三次或四次干预。IST治疗之间的中位时间为32周（范围8 - 133周）。未报告并发症。
我们的研究表明，对于有血栓栓塞性疾病高风险且需要抗凝治疗的SH患者，IST可被视为一种潜在的治疗选择。
