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中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (04) : 225 -240. doi: 10.3877/cma.j.issn.2095-7157.2025.04.003

共识与解读

消化内镜下内痔硬化剂注射术专家共识(2025,广州)
海峡两岸医药卫生交流协会消化内镜学分会痔学组   
  1. 100010 北京,海峡两岸医药卫生交流协会消化内镜学分会痔学组
  • 收稿日期:2025-11-10 出版日期:2025-11-15
  • 基金资助:
    广东省卫生健康适宜技术推广项目(202303221547343843、202303071755524782)

Expert consensus on endoscopic sclerotherapy injection for internal hemorrhoids (2025, Guangzhou)

Hemorrhoid Study Group of the Digestive Endoscopy Branch, Cross-Straits Medicine Exchange Association, Beijing 100010, China   

  • Received:2025-11-10 Published:2025-11-15
引用本文:

海峡两岸医药卫生交流协会消化内镜学分会痔学组. 消化内镜下内痔硬化剂注射术专家共识(2025,广州)[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(04): 225-240.

Hemorrhoid Study Group of the Digestive Endoscopy Branch, Cross-Straits Medicine Exchange Association, Beijing 100010, China. Expert consensus on endoscopic sclerotherapy injection for internal hemorrhoids (2025, Guangzhou)[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(04): 225-240.

痔病是最为常见的肛肠疾病,其中以内痔最为高发。自2019年中华医学会消化内镜学分会成立内痔诊疗协作组以来,在众多临床内镜医师的推动下,消化内镜下内痔微创治疗得以迅速开展。近年来,该技术的多方面优势已得到充分证实,并在国内各级医疗机构逐步普及。2021年,协作组发布《中国消化内镜内痔诊疗指南及操作共识(2021)》[1],系统阐明了消化内镜治疗内痔的临床价值,构建了标准化操作框架,为临床实践提供了坚实的理论依据。随着该技术逐渐普及,操作医生在临床实践中遇到一些亟待解决的实际问题,2024年,中华医学会消化内镜学分会内痔协作组组织专家进行探讨,并更新共识,即《消化内镜内痔微创治疗专家共识(2025,广州)》。此次共识确定了内镜下内痔新分类法:即PBR分类法,并更新了内镜下内痔微创治疗及术后并发症管控等多项内容。基于上述背景,为了进一步细化、规范消化内镜下内痔硬化剂注射术(endoscopic injection sclerotherapy,EIS)的具体实施过程,特别是技术操作过程中细节、围手术期管理、术后并发症的处置等方面提供更详尽的指导。为此,2025年海峡两岸医药卫生交流协会消化内镜学分会痔学组组织全国相关领域权威69位专家研讨,最终制定了《消化内镜下内痔硬化剂注射术专家共识(2025,广州)》,以下简称《共识》,旨在规范硬化剂注射术在内痔治疗中的应用。本《共识》共13个部分,19个临床问题及推荐意见。

Hemorrhoidal disease is the most common anorectal condition, with internal hemorrhoids being the predominant subtype.Since the establishment of the Internal Hemorrhoid Diagnosis and Treatment Collaboration Group under the Digestive Endoscopy Branch of the Chinese Medical Association in 2019, minimally invasive endoscopic treatment for internal hemorrhoids has developed rapidly with the promotion of numerous clinical endoscopists.In recent years, the multifaceted advantages of this technique have been well demonstrated, and it has been gradually implemented at various levels of medical institutions across China.In 2021, the Collaboration Group released the Chinese Guidelines and Expert Consensus on Gastrointestinal Endoscopic Diagnosis and Treatment of Internal Hemorrhoids (2021), which systematically clarified the clinical value of endoscopic treatment for internal hemorrhoids, established a standardized operational framework, and provided a solid theoretical basis for clinical practice.As the technique has become more widely adopted, endoscopists have encountered a number of practical issues in daily practice that call for further refinement and clarification.In 2024, the Internal Hemorrhoid Collaboration Group of the Digestive Endoscopy Branch of the Chinese Medical Association convened experts to discuss and update the previous consensus, resulting in the Expert Consensus on Minimally Invasive Endoscopic Treatment of Internal Hemorrhoids (Guangzhou, 2025), hereinafter referred to as "the Consensus". This Consensus proposes a new endoscopic classification for internal hemorrhoids, namely the PBR classification, and updates several key aspects, including endoscopic sclerotherapy for internal hemorrhoids and the management of postoperative complications.On this basis, in order to further refine and standardize endoscopic sclerosing agent injection for internal hemorrhoids-particularly with respect to technical details, perioperative management, and the handling of postoperative complications-the Hemorrhoid Working Group of the Digestive Endoscopy Branch of the Cross-Strait Medicine and Health Exchange Association organized 69 nationally recognized experts in 2025 to conduct extensive discussion and ultimately formulate the present Consensus.The aim is to standardize the application of sclerosing agent injection in the treatment of internal hemorrhoids.The Consensus is composed of 13 sections and addresses 19 clinical questions with corresponding recommendations.

表1 内痔的Goligher分类
表2 内痔的LDRF分类
表3 中国消化内镜内痔PBR分类
图1 消化内镜下硬化剂注射治疗流程图
图2 消化内镜下硬化剂注射示意图注:A:内痔图示;B:顺镜(正镜)内痔硬化剂注射;C:倒镜内痔硬化剂注射
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