The incidence of internal hemorrhoids is high. Internal hemorrhoids often cause hematochezia. Medication and minimally invasive surgery are effective therapies for internal hemorrhoids, but these two treatments have high rates of recurrence.

To evaluate the efficacy of a Chinese medicine, Huazhi suppository, combined with cap assisted endoscopic sclerotherapy (CAES) for symptomatic internal hemorrhoids and its long-term recurrence rate.

This study selected 104 patients (older than 18 years) with grade Ⅰ-Ⅲ internal hemorrhoids admitted to Guangdong Provincial People's Hospital from January 2018 to June 2020. These patients were randomly assigned into 3 groups by using the single-blind envelope method: medication group (n=31) , CAES group (n=38) and combined group (n=35) . Patients in the medication group received one Huazhi Suppository per time, twice daily for 7 days. Patients in the CAES group received sclerosing agent injection into the hemorrhoidal vein or hemorrhoids exposed by a short transparent cap under the direct vision of flexible endoscope. Patients in the combination group received one Huazhi Suppositoryper time, twice daily for 7 days after the CAES treatment. This study collected the data about clinical efficacy, complications and the satisfaction degree of these three groups, and followed up the recurrence of internal hemorrhoids at one year after treatment.

The rates of overall symptom remission in medication group, CAES group and combined group were 71.0% (22/31) , 100.0% (38/38) and 100.0% (35/35) , respectively. The CAES group and combined group had significant higher rates of overall symptom remission compared with medication group (P<0.001) . The remission rates of hematochezia, perianal discomfort and defecation difficulty were significantly higher in the CAES group and combined group compared with the medication group (P<0.01) . There were no severe adverse events among these three groups. One year after treatment, the recurrence rates of internal hemorrhoids in the medication group, CAES group (n=38) and combined group were 36.4% (8/22) , 15.8% (6/38) and 8.6% (3/35) , respectively. The combined group had lower recurrence rate compared with medication groups (P=0.015) . The satisfactory rates in medication group, CAES group and combined group were 48.4% (15/31) , 78.9% (30/38) , 88.6% (31/35) , respectively. The CAES group and combined group had higher rates of satisfaction compared with the medication group (P<0.05) .

The short-term efficacy of CAES combined with Huazhi Suppository equals to that of CAES group, but better than that of medication group. The long-term recurrence rate of combination group was lower than that of CAES group. We may recommend using CAES combined with Huazhi Suppository.

内痔发病率高，常引起便血，药物和微创治疗有效，但容易复发。

探讨传统中药化痔栓联合透明帽辅助内镜下硬化术（CAES）治疗症状性内痔的效果，并评价远期复发情况。

选取2018年1月至2020年6月于广东省人民医院消化内科就诊的18周岁以上Ⅰ~Ⅲ度内痔患者104例，通过单盲信封法的方式将其随机分为3组：药物组（n=31）、CAES组（n=38）及联合组（n=35）。药物组给予化痔栓早晚各1次塞肛，1枚/次，连续7 d；CAES组接受透明帽辅助暴露痔核，软式内窥镜直视下痔静脉或痔核内硬化剂注射治疗；联合组则于CAES治疗后次日给予化痔栓早晚各1次塞肛，1枚/次，连续7 d。记录三组临床疗效、并发症、患者满意度，并于1年后电话随访患者远期复发情况。

药物组、CAES组、联合组总体症状缓解率为71.0%（22/31）、100.0%（38/38）、100.0%（35/35）。CAES组、联合组总体症状缓解率均高于药物组（P<0.001）。CAES组、联合组便血缓解率、肛门不适缓解率、排便困难缓解率均高于药物组（P<0.01）。三组治疗后均无严重并发症出现。药物组接受随访22例，8例（36.4%）复发；CAES组接受随访38例，6例（15.8%）复发；联合组接受随访35例，3例（8.6%）复发。联合组复发率低于药物组（P=0.015）。三组患者满意率分别为48.4%（15/31）、78.9%（30/38）、88.6%（31/35）。CAES组、联合组满意率均高于药物组（P<0.05）。

CAES联合术后化痔栓塞肛的短期疗效优于单纯药物，与CAES相当，且远期复发率低于CAES，值得临床推广。