3%聚多卡醇泡剂治疗II度痔疮的疗效和安全性 (SCLEROFOAM)
多中心、开放标签、单臂 II 期试验,研究使用 3% 聚多卡醇泡沫进行硬化疗法治疗二度痔疮的疗效和安全性
痔疮疾病 (HD) 是最古老和最常见的直肠疾病之一,据估计患病率在 4.4% 到 86% 之间。 尽管提出了可能构成痔疮发展基础的三种机制——静脉曲张理论、血管增生理论和肛门内膜滑动理论,但对症状性痔病的确切病理生理学知之甚少。
HD 似乎是直肠出血或便血的最常见原因,并且是仅次于憩室炎的严重直肠出血的第二常见原因。 血液呈鲜红色,并在叛逃结束时覆盖粪便。 其他症状包括疼痛、粘液分泌物、瘙痒或组织脱垂感。
最广泛接受的分类是 Goligher 分类:
- I级:痔疮出血但未脱出肛管;
- Ⅱ级:用力或排便时痔垫脱出肛管外,但自行复位;
- Ⅲ级:痔垫用力脱出肛管外,需手法复位;
- Ⅳ级:痔脱垂即使经手法治疗也无法复位
研究概览
详细说明
据意大利结直肠外科学会指南报道,如果保守疗法失败,一级和二级痔疮 (HD) 最常见的门诊治疗是橡皮筋结扎和硬化疗法。
硬化疗法引起粘膜下组织局部硬化的炎症反应,随后痔疮组织固定在下面的组织上。 此外,硬化溶液的作用是通过产生内皮损伤而造成血管损伤。
据报道,II 级和 III 级痔疮患者的出血情况改善了 100%,69% 的非选定患者、52% 的 III 级患者和 88% 的 I 级患者描述了该病症的完全消退。脱垂的消退据报道,受 II 级痔疮影响的患者中有 90-100%。 并发症很少见但很严重,包括阳痿、不可逆坏死性筋膜炎和腹腔间隔室综合征 [31-33]。 在德国,液体药剂硬化疗法被认为是治疗Ⅰ级痔疮的首选。 德国当局唯一批准的医疗产品是聚多卡醇 (Lauromacrogol 400 (INN), H3C-(CH2)11-(O-CH2-CH2)n∼9-OH),由 Chemische Fabrik Kreussler & Co. GmbH 生产。
在意大利,这种药物被称为 Atossisclerol 3%。 聚多卡醇是一种非离子型洗涤剂,由亲水性聚环氧乙烷链与脂肪族疏水性十二烷醇混合而成,推荐用于一级和二级 HD。 聚多卡醇的作用与酚油相似,但副作用较少。
基于这些经验,Karl-Heinz Moser介绍了使用聚多卡醇泡沫治疗I级痔疮。 2013 年,同一作者发表了一项随机、对照、单盲、多中心试验的结果,比较聚多卡醇泡沫硬化疗法与液体硬化剂治疗 I 级痔疮的疗效和安全性 [28]。 在泡沫组中,一次硬化治疗后的成功率为 88%,而使用液体聚多卡醇治疗的患者的成功率为 69%。 此外,用泡沫治疗的患者比用液体聚多卡醇治疗的患者更满意(99% 对 84% p=0.009)。 最后,泡沫组注射的聚多卡醇的量明显较低(p
总之,根据作者的说法,这些结果表明聚多卡醇泡沫可以用作 I 级 HD 的治疗选择。
本研究的目的是评估使用 3% 聚多卡醇泡沫 (PF) 的硬化疗法对二度 HD 患者的疗效和安全性。
研究类型
注册 (实际的)
阶段
- 阶段2
联系人和位置
学习地点
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Catanzaro、意大利、88100
- University of Catanzaro
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
纳入标准:
- 确诊为二度 HD 的 18 岁以上 75 岁以下患者(直肠镜检查、直肠镜检查,必要时进行结肠镜检查)
- 将持续性肛周出血报告为二度 HD 典型症状的患者
- 必须获得每位患者的知情同意
- 参与中心将被要求确认他们已在其现场获得正式批准
排除标准:
- 以前的肛门外科手术
- 过去 12 个月内进行过硬化疗法或橡皮筋结扎
- 妊娠试验阳性
- 无法返回进行术后控制访视、签署知情同意书或填写所需临床日记的患者
- 哺乳
- 已知对聚多卡醇过敏
- 急性肛周血栓形成
- 肛瘘
- 肛裂
- 直肠炎
- 大便失禁
- 凝血障碍
- 抗凝治疗
- 已知的 HBV、HCV 和 HIV 感染
- 急性克罗恩病或溃疡性结肠炎
- I型和II型糖尿病
- 慢性阻塞性肺病
- 任何类型的肿瘤
- 既往盆腔放疗
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:聚多卡醇 3% 泡沫
根据纳入和排除标准,参与研究的患者将接受使用聚多卡诺泡沫(Atossisclerol® 3%,Chemische Fabrik Kreussler & Co. GmbH,威斯巴登,德国)进行的硬化疗法。
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该程序将在 Sims 位置或截石位置进行。
采用改良的 Blonde-Blanchard 技术,将聚多卡醇泡沫切向注射到每个痔疮桩尖的粘膜下层,不超过三桩,并使用自发光开口肛门镜和 20-G 针头为了减少出血
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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成功率 1
大体时间:12个月的随访
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确定一次硬化治疗后的成功率,根据注射后一周出血事件的完全解决情况 出血将使用痔疮疾病症状评分和 Giamundo 评分进行评估。 Rørvik HD 等人 (2019) Hemorrhoidal Disease Symptom Score and Short Health ScaleHD:评估痔疮症状和健康相关生活质量的新工具。 Dis结肠直肠; 62:333-342 Giamundo 等人 (2018) 多普勒引导的激光痔动脉除动脉术 (HeLP):一项多中心试验数据的前瞻性分析。 Tech Coloproctol; 25:635-643 |
12个月的随访
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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成功率 2
大体时间:12个月的随访
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根据症状的部分或完全解决确定成功率 症状将使用 Rorvik HD 描述的痔疮疾病症状评分进行评估 |
12个月的随访
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门诊次数
大体时间:12个月的随访
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评估治疗成功所需的平均门诊次数
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12个月的随访
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并发症发生率 - 不良事件
大体时间:6个月随访
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确定并发症发生率
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6个月随访
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生活质量
大体时间:12个月的随访
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矮个子健康量表 HD 4 个问题,每个问题采用 7 分 Liker 量表(1 = 非常不满意,7 = 非常满意) 最小 = 4 最大值 = 28 |
12个月的随访
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确定实现自治所需的平均时间
大体时间:12个月的随访
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我们将自主性视为恢复正常活动:除了退休患者的情况外,它还包括重返工作岗位,我们将其视为完全恢复日常活动
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12个月的随访
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合作者和调查者
调查人员
- 首席研究员:Gaetano Gallo, MD、Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro 88100, Italy
出版物和有用的链接
一般刊物
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- Gupta PJ, Heda PS, Kalaskar S. Randomized controlled study between suture ligation and radio wave ablation and suture ligation of grade III symptomatic hemorrhoidal disease. Int J Colorectal Dis. 2009 Apr;24(4):455-60. doi: 10.1007/s00384-008-0579-9. Epub 2008 Sep 7.
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- Tejirian T, Abbas MA. Bacterial endocarditis following rubber band ligation in a patient with a ventricular septal defect: report of a case and guideline analysis. Dis Colon Rectum. 2006 Dec;49(12):1931-3. doi: 10.1007/s10350-006-0769-x.
- Sim HL, Tan KY, Poon PL, Cheng A, Mak K. Life-threatening perineal sepsis after rubber band ligation of haemorrhoids. Tech Coloproctol. 2009 Jun;13(2):161-4. doi: 10.1007/s10151-008-0435-5. Epub 2008 Aug 5.
- Yano T, Asano M, Tanaka S, Oda N, Matsuda Y. Prospective study comparing the new sclerotherapy and hemorrhoidectomy in terms of therapeutic outcomes at 4 years after the treatment. Surg Today. 2014 Mar;44(3):449-53. doi: 10.1007/s00595-013-0564-y. Epub 2013 Mar 30.
- Miyamoto H, Asanoma M, Miyamoto H, Shimada M. ALTA injection sclerosing therapy:non-excisional treatment of internal hemorrhoids. Hepatogastroenterology. 2012 Jan-Feb;59(113):77-80. doi: 10.5754/hge11089.
- Tokunaga Y, Sasaki H. Impact of less invasive treatments including sclerotherapy with a new agent and hemorrhoidopexy for prolapsing internal hemorrhoids. Int Surg. 2013 Jul-Sep;98(3):210-3. doi: 10.9738/INTSURG-D-13-00030.1.
- Takano M, Iwadare J, Ohba H, Takamura H, Masuda Y, Matsuo K, Kanai T, Ieda H, Hattori Y, Kurata S, Koganezawa S, Hamano K, Tsuchiya S. Sclerosing therapy of internal hemorrhoids with a novel sclerosing agent. Comparison with ligation and excision. Int J Colorectal Dis. 2006 Jan;21(1):44-51. doi: 10.1007/s00384-005-0771-0. Epub 2005 Apr 21.
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- Bullock N. Impotence after sclerotherapy of haemorrhoids: case reports. BMJ. 1997 Feb 8;314(7078):419. doi: 10.1136/bmj.314.7078.419. No abstract available.
- Schulte T, Fandrich F, Kahlke V. Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. Int J Colorectal Dis. 2008 Jul;23(7):725-6. doi: 10.1007/s00384-007-0402-z. Epub 2007 Nov 28. No abstract available.
- Yang P, Wang YJ, Li F, Sun JB. Hemorrhoid sclerotherapy with the complication of abdominal compartment syndrome: report of a case. Chin Med J (Engl). 2011 Jun;124(12):1919-20.
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- Namasivayam J, Payne D, Maguire D. Prostatic abscess following injection of internal haemorrhoids. Clin Radiol. 2000 Jan;55(1):67-8. doi: 10.1053/crad.1999.0066. No abstract available.
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研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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聚多卡醇泡沫(Atossisclerol® 3%)的临床试验
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Fondazione IRCCS Ca' Granda, Ospedale Maggiore...招聘中
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AstraZeneca完全的2型糖尿病 | 外分泌性胰腺功能不全瑞典, 波兰, 拉脱维亚, 丹麦, 匈牙利, 斯洛伐克
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Photolitec LLCNational Cancer Institute (NCI); Roswell Park Cancer Institute招聘中
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Virginia Commonwealth UniversityBill and Melinda Gates Foundation完全的