3)直腸・肛門静脈瘤（内痔核）

Endoscopic Treatment for Rectal-anal Varices and Internal Hemorrhoids

要旨　直腸静脈瘤，内痔核に対する内視鏡治療を述べた．内視鏡的結紮術では，反転能が優れている内視鏡を用い，結紮器具は食道静脈瘤用の器具を使用する．観察後，内視鏡の先端に結紮器具を装着し，静脈瘤や内痔核を結紮する．内視鏡的硬化療法は，食道静脈瘤用の硬化療法針を使用し，静脈瘤や内痔核周囲の粘膜下層に0.5～1％のaethoxysklerolを注入するか，あるいは静脈瘤を穿刺し血液の逆流を確認後，透視下で5％ethanolamine oleate with iopamidolを用いて静脈瘤造影を行う．門脈圧亢進症患者の下血には内視鏡治療が推奨される．痔核出血では，まずは肛門鏡下止血を行う．

　We described endoscopic treatments for rectal varices and internal hemorrhoids. In endoscopic variceal ligation, a flexible endoscope and a ligation device for esophageal varices are used. After observation by an endoscope, a ligation device is attached to the tip of a scope and varices and internal hemorrhoids are ligated.

　In endoscopic sclerotherapy, using a sclerotherapy needle for esophageal varices, aethoxysklerol of 0.5～1％ is injected into the submucosal layer surrounding the varices and internal hemorrhoids. An alternative is after sticking a needle into the varices and affirmation of a hemal countercurrent, 5％ ethanolamine oleate with iopamidol is injected directly into the varices and varicography is performed.

　Endoscopic treatment is recommended in cases of bloody discharge of portal hypertension patients. For bleeding of hemorrhoids, we first perform hemostasis under an anoscope.