腎不全透析内痔核患者に対する痔核硬化剤ALTA(ジオン^【○!R】注)治療の1例と臨床的意義 A Case of Sclerotherapy Using a Novel Agent (ALTA, ZIONE^【○!R】) for Prolapsed Internal Hemorrhoids with Renal Failure under Hemodialysis and its Clinical Significance

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腎不全透析内痔核患者に対する痔核硬化剤ALTA(ジオン<sup>®</sup>注)治療の1例と臨床的意義を報告した.内痔核3度脱肛に肛門出血を繰り返す透析患者では抗凝固剤など休薬は行えず,後出血など危険性が高く透析患者の観血手術は回避されている.ALTAは痔核に対し安全,低侵襲であるが,本剤は透析患者には安全性未確認のため禁忌となっている.ALTAに関する安全性と危険性について十分な説明合意と院内倫理委員会の許可のもと,アルミニウム血清中濃度を測定し3カ所の内痔核に分割投与した.臨床的に問題なく経過,止血し脱肛治癒と血清中アルミニウムの安全域濃度が確認された.文献および使用薬剤量から推測すれば,ALTA投与による慢性副作用発現の可能性は低い.さらに倫理的承認と臨床検証の多施設研究を行えば,透析患者の治療に禁忌となっているALTAは慎重投与可能な治療薬剤になると考えられた.<br>

We report a case and the safety of a new sclerotherapeutic Alum [ALTA, ZIONE<sup>®</sup>] injection for a patient with IIIrd degree hemorrhoids and renal failure under hemodialysis. It is difficult to stop the anticoagulants and other drugs for patients with hemorrhoids under hemodialysis, and it is also difficult to control post-operative massive bleeding. Surgical operation for such patients carries a high risk and should be avoided, however, usage of ALTA is beneficial and the first option for such patients due to its pharmacological efficacies and advantages if the serum level of aluminum is confirmed to be safe. After obtaining permission from the ethics committee, we gained a patient's consent to sclerotherapy and serum aluminum examination.<br> ALTA was injected by a four-step, three-stage for each pile method during three months. No problems occurred clinically, and we checked the healed state of piles and safe level of serum aluminum. Efficacy, safety and pharmacokinetics of ALTA were recognized and, judging from literatures, adverse effect were dose dependent of aluminum.<br> We suggest that ALTA injection therapy is a first and safe choice for patients with renal failure under hemodialysis, and under ethical and multi-center research we propose cautious use of ALTA in cases without contraindications. <br>

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  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 61(2), 71-75, 2008-02-01 

    The Japan Society of Coloproctology

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