经皮超选择直肠上动脉栓塞术治疗Ⅱ-Ⅲ度内痔的临床分析

Clinical analysis of percutaneous superselective superior rectal artery embolization for grades Ⅱ-Ⅲ internal hemorrhoids

目的探讨经皮超选择直肠上动脉栓塞术治疗Ⅱ度和Ⅲ度内痔的安全性和有效性。方法回顾性分析2019年9月至2022年2月在山东大学第二医院介入与肿瘤微创治疗科通过超选择直肠上动脉栓塞术治疗的22例Ⅱ度和Ⅲ度内痔患者的临床资料。依据痔丛供血动脉采用栓塞材料进行超选择性栓塞治疗, 分析手术疗效、术后并发症及12个月随访结果。临床评分数据(法国出血评分、生活质量评分、脱垂评分)用M(Q_(1), Q_(3))表示, 治疗前后临床评分比较采用非参数秩和检验(Wilcoxon检验), 计算Z值, P<0.05为差异有统计学意义。结果 22例患者手术均取得成功, 技术成功率100%。术后主要副反应、并发症包括:里急后重感81.8%(18/22)、肛门坠胀感68.2%(15/22)、肛门部位轻度疼痛22.7%(5/22), 以上反应多在术后3~5 天好转, 3例患者穿刺部位淤血、隐痛, 未经治疗, 自行好转。术后随访12个月。与术前比较, 法国出血评分、生活质量评分、脱垂评分明显改善(均P<0.05)。结论超选择直肠上动脉栓塞术治疗Ⅱ~Ⅲ度内痔是相对安全, 低风险的治疗方法, 可作为内痔治疗的可选方案之一, 特别适合出血性内痔的治疗。

Objective To investigate the safety and efficacy of percutaneous superselective superior rectal artery embolization in the treatment of grades Ⅱ-Ⅲ internal hemorrhoids.Methods The clinical data of 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids who underwent superselective superior rectal artery embolization in the Department of Interventional and Minimally Invasive Tumor Therapy of the Second Hospital of Shandong University from September 2019 to February 2022 were retrospectively analyzed.According to the blood supply artery of hemorrhoids,superselective embolization was performed with embolization materials.The surgical efficacy,postoperative complications,and 12-month follow-up results were analyzed.The clinical score data(French bleeding score,quality of life score,prolapse score)were expressed using the median(Q_(1), Q_(3)).The clinical scores before and after treatment were compared by the nonparametric rank sum test(Wilcoxon test),and the Z-value was calculated.P-values<0.05 indicate statistically significant differences.Results The operation was successful in all 22 patients(technical success rate:100%).The main postoperative side effects and complications included tenesmus(81.8%,18/22),anal bulge(68.2%,15/22),and mild pain in the anus(22.7%,5/22).The above reactions were improved 3-5 days after operation;three patients had congestion and dull pain at the puncture site,which improved spontaneously without treatment.The patients were followed up for 12 months.Compared with those prior to operation,the French bleeding score,quality of life score,and prolapse score were significantly improved(all P<0.05).Conclusion Superselective superior rectal artery embolization is a relatively safe and low-risk treatment for grades Ⅱ-Ⅲ internal hemorrhoids.It is an option for the treatment of internal hemorrhoids,particularly hemorrhagic internal hemorrhoids.