Hemorrhoids are one of the common diseases in anus and intestines, and injection therapy is a commonly used treatment, but there is a lack of national data on the depth and standardized application of injection therapy, so it is necessary to carry out this research study.

To investigate the depth and breadth, standardized application, effectiveness and safety of hemorrhoidal injection therapy and the reasons for its failure to be carried out in China.

An online questionnaire was issued to the members of the Professional Committee of Anal and Intestinal Diseases of the Chinese Association for Medical Education from July to November 2022, and the content of the questionnaire was designed by ourselves, with a total of 37 questions, including demographic information, methods of treating hemorrhoids, the application of injectable treatments, and complications, etc. The data were statistically analyzed using SPSS 21.0 software.

A total of 335 questionnaires were recovered and 312 questionnaires were valid (93.1% recovery rate). There were 293 (93.9%) doctors using sclerotherapy, 153 (54.2%) doctors implementing more than 500 cases of injection therapy, and the difference was not statistically significant when comparing the number of injection therapy carried out by anorectal doctors of different hospital levels, hospital natures, and types of hospitals (P>0.05). 293 (93.9%) and 263 (84.3%) doctors believed that injection therapy was suitable for the treatment of internal hemorrhoids and the internal portion of mixed hemorrhoids. For internal hemorrhoids of degree Ⅰ and Ⅱ, the percentage of sclerotherapy injection was 55.4% (173/312) and 79.2% (247/312), respectively. For the choice of anesthesia, local anesthesia was predominant in 229 (73.4%) and lumbar anesthesia in 145 (46.5%) cases. Sclerotherapy was applied in 280 (89.7%), accounting for the first use of sclerotherapy; 201 (64.4%) chose to treat three hemorrhoids in a single treatment, and for hemorrhoids in the anterior part of the anus, 140 (44.9%) of the physicians thought that they could be injected, while 172 (55.1%) thought that sclerotherapy should not be injected. Dosage analysis showed that anti-hemorrhoidal sclerotherapy single site injections were concentrated at 1-5 mL in 80.7% (92/114) and low-dose (0-3 mL) regimens in 56.7% (59/104) of cases; despite the fact that 233 (74.7%) endorsed the curative properties of injections alone, 227 (88.8%) of the clinical practices combined the procedures, with hemorrhoidectomies accounting for 64.7% (202/312) of the cases. The 1-year recurrence rate of <10% assessed for injection alone amounted to 90.3% (233/258), but decreased to 58.9% (146/248) at the 5-year assessment; the complication rate of patients treated with injections showed anal pain in 134 (42.9%), urinary retention in 90 (28.8%), and hardness at the injection site in 182 (58.3%), which were the common complications. Other serious complications included perianal abscess (5.1%, 16 cases), sepsis (1.3%, 4 cases) and rectal perforation (1.6%, 5 cases). The main reasons for not carrying out injection therapy were cited by 15 (35.7%) as hospital management factors, 9 (21.4%) as price, 8 (19.0%) as questionable efficacy, and 6 (14.3%) as drug shortage.

Hemorrhoid injection therapy has been widely recognized and applied by anorectal physicians in China, with 93.9% of physicians carrying out this therapy, more than 54.2% operating more than 500 cases, and the popularity of this therapy did not differ significantly among all levels and types of hospitals. At least 55.4% of doctors can standardize the indications (Ⅰ-Ⅱ degree internal hemorrhoids are more inclined to use injection treatment). Anti-hemorrhoidal spirit is the most commonly used sclerosing agent, and more than 3 hemorrhoid nuclei are injected at one time. Hemorrhoidal injection therapy is efficacious, with 90% of physicians reporting a 1-year recurrence rate of <10%, and long-term recurrence rate data supporting its reliability. Nearly 90% of physicians preferred to combine with other procedures, reflecting a lack of confidence in injections alone and the need to clarify the "symptomatic relief" goal of device therapy and improve patient communication. Hemorrhoidal injection therapy as a safe and effective hemorrhoidal management tool is suitable for national promotion, but needs to strengthen the operation standardization training and complication prevention and control system construction.

痔病是肛肠科常见疾病之一，注射治疗是常用的治疗方法，但目前关于注射治疗的应用深度、规范应用情况等方面的全国性数据较为缺乏，因此有必要开展此项调查研究。

探究当前痔注射治疗在中国开展的深度和广度、规范性应用情况、有效性和安全性及未能开展的原因。

于2022年7—11月对中国医药教育协会肛肠疾病专业委员会的委员发布线上问卷，自行设计问卷内容，共37个问题，包括人口学资料、治疗痔的方法、注射治疗的应用情况、并发症等问题，应用SPSS 21.0软件进行数据统计分析。

共回收335份问卷，有效问卷312份（有效回收率为93.1%）。有293名（93.9%）医生使用硬化剂注射治疗，153名（54.2%）医生实施500例以上的注射治疗，且不同医院级别、医院性质、医院类型的肛肠医生开展注射治疗的数量比较，差异均无统计学意义（P>0.05）。分别有293名（93.9%）、263名（84.3%）医生认为注射治疗适合于治疗内痔、混合痔的内痔部分。对于Ⅰ、Ⅱ度内痔，硬化剂注射占比分别为55.4%（173/312）、79.2%（247/312）。对于麻醉方式的选择，以局部麻醉229例（73.4%）和腰麻145例（46.5%）为主。有280名（89.7%）应用过消痔灵注射液，占硬化剂使用首位；有201名（64.4%）选择单次治疗3个痔核，对于肛门前部的痔核，有140名（44.9%）医生认为可以予以注射，172名（55.1%）医生认为不应该予以注射硬化剂。剂量分析显示消痔灵单处注射集中于1~5 mL，占比80.7%（92/114），低剂量（0~3 mL）方案占56.7%（59/104）；尽管有233名（74.7%）认可单独注射的治愈性，但227名（88.8%）临床实践仍联合术式，其中痔切除术占64.7%（202/312）。单独注射的1年复发率<10%评估达90.3%（233/258），但5年评估下降至58.9%（146/248）；采用注射治疗的患者中，肛门疼痛134例（42.9%）、尿潴留90例（28.8%）、注射部位硬结182例（58.3%），为常见并发症，其他严重并发症包括肛周脓肿（5.1%，16例）、败血症（1.3%，4例）及直肠穿孔（1.6%，5例）。未开展注射治疗的主要原因，15名（35.7%）认为是医院管理因素、9名（21.4%）认为是价格问题、8名（19.0%）对疗效质疑、6名（14.3%）认为药品短缺。

痔注射疗法在中国已获肛肠科医生广泛认可与应用，93.9%的医生开展此疗法，超54.2%的医生操作超500例，且普及度在各级各类医院中无显著差异。至少55.4%的医生能规范掌握适应证（Ⅰ~Ⅱ度内痔更倾向于采用注射治疗）。消痔灵为最常用硬化剂，一次多注射3处痔核。痔注射疗法疗效确切，90%医生报告1年复发率<10%，长期复发率数据支持其可靠性。近90%医生倾向联合其他术式，反映对单独注射信心不足，需明确器械治疗"减轻症状"的目标并加强医患沟通。痔注射疗法作为安全有效的痔病管理手段适合全国推广，但需加强操作规范化培训与并发症防控体系建设。