直肠上动脉介入栓塞术治疗Ⅱ~Ⅳ度内痔的可行性及安全性分析  

Safety and feasibility of interventional superior rectal artery embolization?in the treatment of II-IV degree of internal hemorrhoids

作　　者：罗春生 茅爱武[2] 贾一平[2] 汪庆明[1] 杨巍[1] Luo Chunsheng;Mao Aiwu;Jia Yiping;Wang Qingming;Yang Wei(Shuguang Affiliated Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China;Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200051, China)

机构地区：[1]上海中医药大学附属曙光医院,上海201203 [2]上海交通大学医学院附属同仁医院,上海200051

出　　处：《结直肠肛门外科》2018年第2期108-113,共6页Journal of Colorectal & Anal Surgery

基　　金：上海市科委项目(14401931000、2014/06-2016/12)

摘　　要：目的探讨直肠上动脉栓塞术治疗中、重度内痔的可行性及安全性。方法对本协作组2014年7月至2016年12月收治并行直肠上动脉栓塞术治疗的26例Ⅱ~Ⅳ度内痔患者的治疗效果进行分析,患者依据Goligher痔分度为Ⅱ度8例、Ⅲ度14例、Ⅳ度4例,治疗方案采用弹簧圈栓塞2例、聚乙烯醇微粒6例、明胶海绵颗粒2例、无水乙醇5例、白芨胶加明胶海绵颗粒11例。结果操作成功率100%,单侧单支栓塞6例、双侧单支栓塞17例、单侧双支栓塞3例,平均手术时间(39.05±14.20)min,术后平均住院天数(2.90±1.50)d。所有患者术后鲜红色出血症状减轻或消失,未出现异位栓塞及肠管缺血坏死、穿孔等情况,所有患者内痔降度明显。结论直肠上动脉栓塞术治疗以出血为主的Ⅱ～Ⅳ度内痔有良好的疗效,手术创伤小、患者痛苦小,适用患者较广,是一种值得推荐的微创治疗方式。Objective To investigate the feasibility and safety of interventional superior rectal artery embolization in the treatment of II-IV degree of internal hemorrhoids. Methods We analyzed the clinical efficacy of 26 patients with Ⅱ ~ Ⅳ degree of internal hemorrhoids who received interventional superior rectal artery embolization in our collaboration group from July 2014 to December2016. According to Goligher classification, there were 8 patients with II degree, 14 with III degree, and 4 with IV degree hemorrhoids.Two patients received spring coil embolism, 6 received polyvinyl alcohol（PVA） particles, 2 received gelfoam particles, 5 received anhydrous ethanol, and 11 received Bletilla gum and gelatin sponge particles. Results The success rate was 100%. There were 6 unilateral single branch embolization, 17 bilateral single branch embolization and 3 unilateral double branch embolism. The mean operative duration was（39.05±14.20） min and the average postoperative hospital duration was（2.90±1.50） d. All patients reported relief or disappearance of symptoms of bright red bleeding after operation. There was no ectopic embolism or ischemic necrosis or perforation of bowel. All the patients had a lower degree of hemorrhoids after operation. Conclusion Interventional superior rectal artery embolization has satisfactory effect for patients with internal hemorrhoids of Ⅱ ~ Ⅳ degree with a main symptom of bleeding, with limited injury, less pain and wide application. It is a recommendable minimally invasive treatment.

关 键 词：内痔 介入栓塞 直肠上动脉 

分 类 号：R657.1[医药卫生—外科学]