3例痔术后难治性出血患者介入治疗的即刻疗效与长期预后

doi:10.6040/j.issn.1671-7554.0.2022.1354

摘要/Abstract

摘要： 目的探讨痔手术后难治性出血经介入治疗的即刻疗效及长期预后。方法回顾性分析3例行介入治疗的痔手术后反复多次出血患者的临床资料,随访时间分别为114个月、110个月、78个月,3例患者均经造影后明确出血部位,分别为左侧直肠上动脉分支末端造影剂外溢、直肠上动脉分支末端造影剂外溢和左侧髂内动脉末端血管造影剂外溢;2例一次栓塞成功,1例栓塞后再次出血行第二次介入治疗后成功止血。3例患者经介入治疗后均未再出血。结果 3例患者均止血确切,无肠坏死、死亡等严重并发症,均有肛门下坠、疼痛症状;1例出现阴囊水肿、勃起障碍,长期随访后又恢复。结论介入栓塞治疗难治性痔术后持续性出血,即刻疗效显著,但安全性需要多中心及大样本的长期随访与观察。

关键词: 痔, 术后, 出血, 介入, 栓塞

Abstract: Objective To investigate the immediate efficacy and long-term prognosis of patients with repeated bleeding after interventional therapy. Methods The clinical data of three patients with repeated bleeding after hemorrhoidal surgery were retrospectively analyzed at the follow-up of 114, 110 and 78 months, respectively. The bleeding sites were the end of the left superior rectal artery, the end of the superior rectal artery branch and the end of the left internal iliac artery. Two cases had successful first-stage embolization, and one case had re-bleeding after first-stage embolization and successfully stopped bleeding after a second interventional treatment. No patients had bleeding after interventional treatment. Results All three patients had accurate hemostasis, and there were no serious complications such as intestinal necrosis and death. All patients had falling and painful symptoms; One patient developed scrotal edema and erectile dysfunction, and recovered after long-term follow-up. Conclusion Interventional embolization is effective in the treatment of persistent bleeding after refractory hemorrhoids, but the safety requires long-term follow-up and observation of multi-center and large samples.

Key words: Hemorrhoids, Postoperative, Hemorrhage, Intervention, Embolism

中图分类号:

R657

崔振华,李志文,王贤仁,刘贞吉,商庆新,吕艳锋. 3例痔术后难治性出血患者介入治疗的即刻疗效与长期预后[J]. 山东大学学报 (医学版), 2023, 61(5): 68-72.

CUI Zhenhua, LI Zhiwen, WANG Xianren, LIU Zhenji, SHANG Qingxin, LYU Yanfeng. Immediate efficacy and long-term prognosis analysis of 3 cases interventional treatment of refractory bleeding after hemorrhoidal surgery[J]. Journal of Shandong University (Health Sciences), 2023, 61(5): 68-72.

参考文献

[1] Yeo D, Tan KY. Hemorrhoidectomy-making sense of the surgical options [J]. World J Gastroenterol, 2014, 20(45): 16976-16983.
[2] van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: guideline for haemorrhoidal disease [J]. Colorectal Dis, 2020, 22(6): 650-662.
[3] Madoff RD, Fleshman JW. American, Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids [J]. Gastroenterology, 2004, 126(5): 1463-1473.
[4] Walker TG, Salazar GM, Waltman AC. Angiographic evaluation and management of acute gastrointestinal hemorrhage [J]. World J Gastroenterol, 2012, 18(11): 1191-1201.
[5] Romano FM, Sciaudone G, Canonico S, et al. Scoring system for haemorrhoidal disease [J]. Rev Recent Clin Trials, 2021, 16(1): 96-100.
[6] Lohsiriwat V. Treatment of hemorrhoids: a coloproctologists view [J]. World J Gastroenterol, 2015, 21(31): 9245-9252.
[7] Milligan ET, Morgan CN, Jones LE, et al. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids [J]. Lancet, 1937: 119-124. doi: 10.1016/S0140-6736(00)88465-2.
[8] Racalbuto A, Aliotta I, Corsaro G, et al. Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial [J]. Int J Colorectal Dis, 2004, 19(3): 239-244.
[9] Moon SB, Park KW, Jung SE. Abnormal direct entry of the umbilical vein into the portal vein: report of a case [J]. Pediatr Surg Int, 2008, 24(11): 1243-1245.
[10] Schuetz A, Jauch KW. Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results [J]. Langenbecks Arch Surg, 2001, 386(1): 17-25.
[11] Brunnler T, Klebl F, Mundorff S, et al. Significance of scintigraphy for the localisation of obscure gastrointestinal bleedings [J]. World J Gastroentero, 2008, 14(32): 5015-5019.
[12] Geffroy Y, Rodallec MH, Boulay-Coletta I, et al. Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how [J]. Radiographics, 2011, 31(3): E35-46.
[13] 贺祥, 张和平, 靳海英, 等. DSA下急性消化道出血的介入治疗[J]. 河南大学学报(医学版), 2008, 27(3): 51-52. HE Xiang, ZHANG Heping, JIN Haiying, et al. Interventional treatment of acute gastrointestinal bleeding under DSA [J]. Journal of Henan University(Medical Sciences), 2008, 27(3): 51-52.
[14] Aigner F, Bodner G, Gruber H, et al. The vascular nature of hemorrhoids [J]. J Gastrointest Surg, 2006, 10(7): 1044-1050.
[15] Scheyer M, Antonietti E, Rollinger G, et al. Doppler-guided hemorrhoidal artery ligation [J]. Am J Surg, 2006, 191(1): 89-93.
[16] Vidal V, Louis G, Bartoli JM, et al. Embolization of the hemorrhoidal arteries(the emborrhoid technique): a new concept and challenge for interventional radiology [J]. Diagn Interv Imaging, 2014, 95(3): 307-315.
[17] Nguyenhuy M, Xu Y, Kok HK, et al. Clinical outcomes following rectal artery embolisation for the treatment of internal haemorrhoids: a systematic review and meta-analysis [J]. Cardiovasc Intervent Radiol, 2022, 45(9): 1351-1361.
[18] Huang CC, Lee CW, Hsiao JK, et al. N-butyl cyanoacrylate embolization as the primary treatment of acute hemodynamically unstable lower gastrointestinal hemorrhage [J]. J Vasc Interv Radiol, 2011, 22(11): 1594-1599.
[19] Guy GE, Shetty PC, Sharma RP, et al. Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles [J]. AJR Am J Roentgenol, 1992, 159(3): 521-526.
[20] Tradi F, Vidal V. Hemorrhoid embolization: is it time for standardization? [J]. Cardiovasc Intervent Radiol, 2022, 45(9): 1362-1363
[21] Hastings GS. Angiographic localization and transcatheter treatment of gastrointestinal bleeding [J]. Radiographics, 2000, 20(4): 1160-1168.
[22] Talaie R, Torkian P, Moghadam AD, et al. Hemorrhoid embolization: a review of current evidences [J]. Diagn Interv Imaging, 2022, 103(1): 3-11.
[23] Makris GC, Thulasidasan N, Malietzis G, et al. Catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoids: a Meta-analysis of the clinical evidence [J]. J Vasc Interv Radiol, 2021, 32(8): 1119-1127
[24] Ferrer Puchol MD, Esteban Hernández E, Blanco González FJ, et al. Selective intra-arterial embolization to treat hemorrhoids [J]. Radiologia(EnglEd), 2020, 62(4): 313-319.
[25] Thomson WH. The nature of haemorrhoids [J]. BrJurg, 1975, 62(7): 542-552.
[26] Zakharchenko A, Kaitoukov Y, Vinnik Y, et al. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids(Emborrhoid technique)[J]. Diagn Interv Imaging, 2016, 97(11): 1079-1084.
[27] Moussa N, Bonnet B, Pereira H, et al. Mid-term results of superior rectal artery and coils for hemorrhoidal embolization with particles bleeding [J]. Cardiovasc Intervent Radiol, 2020, 43(7): 1062-1069.

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