Itatani Yoshiro, Okada Tomoaki, Kawada Kenji, Hida Koya, Oshima Nobu, Inamoto Susumu, Mizuno Rei, Okuchi Yoshihisa, Sakai Yoshiharu
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
Surg Case Rep. 2019 Oct 29;5(1):160. doi: 10.1186/s40792-019-0715-5.
Internal hemorrhoids are the most common anal diseases. Aluminum potassium sulfate and tannic acid (ALTA) injection is a new sclerosing therapy for the treatment of internal hemorrhoids. Although ALTA injection has been widely used, there are no previous reports of rectal cancer patients who underwent robot-assisted low anterior resection (Rob-LAR) after ALTA injection to treat internal hemorrhoids.
A 70-year-old man with rectal cancer was presented to our hospital. He had an ALTA injection 2 months before presentation at a clinic due to hematochezia with internal hemorrhoids. The rectal tumor was located 7 cm above the anal verge, and Rob-LAR with the da Vinci Xi system was performed. The patient had sclerosis on the stump of the anal side, which made it difficult to transect the rectum with linear staplers. This required multiple repeats of compression through the SmartClamp feedback. After anastomosis with the double-stapling technique, we constructed a diverting ileostomy.
Although ALTA injection is a promising strategy for internal hemorrhoids, rectal cancer should be excluded before the sclerosing therapy.
内痔是最常见的肛门疾病。硫酸铝钾和鞣酸（ALTA）注射是一种治疗内痔的新型硬化疗法。尽管ALTA注射已被广泛应用，但此前尚无关于内痔接受ALTA注射治疗后行机器人辅助低位前切除术（Rob-LAR）的直肠癌患者的报道。
一名70岁的直肠癌男性患者被送至我院。他因内痔便血在诊所就诊前2个月接受了ALTA注射。直肠肿瘤位于肛缘上方7厘米处，采用达芬奇Xi系统进行了Rob-LAR手术。患者肛门侧残端有硬化，这使得用直线缝合器横断直肠变得困难。这需要通过SmartClamp反馈多次重复压迫。采用双吻合器技术吻合后，我们做了一个转流性回肠造口术。
尽管ALTA注射是治疗内痔的一种有前景的策略，但在硬化治疗前应排除直肠癌。
