Clinical features of ectopic varices in Tokai University School of Medicine
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- Kojima S
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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- Numata M
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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- Nagata N
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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- Shiozawa H
- Division of Gastroenterology, Department of Internal Medicine, Tokai University Tokyo Hospital
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- Motegi N
- Division of Gastroenterology, Department of Internal Medicine, Tokai University Tokyo Hospital
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- Nishizaki Y
- Division of Gastroenterology, Department of Internal Medicine, Tokai University Tokyo Hospital
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- Hirose T
- Division of Gastroenterology, Department of Internal Medicine, Tokai University Hachioji Hospital
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- Shiraishi K
- Division of Gastroenterology, Department of Internal Medicine, Tokai University Hachioji Hospital
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- Koizumi J
- Department of Radiology, Tokai University School of Medicine
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- Kagawa T
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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- Watanabe N
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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- Mine T
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine
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- Makuuchi H
- Department of Surgery, Tokai University School of Medicine
Bibliographic Information
- Other Title
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- 当病院群における異所性静脈瘤の実態
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Abstract
過去8年間に経験した異所性静脈瘤18例(男性12例,女性6例)を対象として異所性静脈瘤の臨床像を検討した.異所性静脈瘤の部位は,直腸11例(61%),十二指腸7例(39%)であった.基礎疾患は直腸静脈瘤ではC型肝炎ウイルス(hepatitis type C virus; HCV)による肝硬変(liver cirrhosis; LC) 4例(36%),B型肝炎ウイルス(hepatitis type B; HBV)によるLCと原因不明のLCが各2例(18%),アルコール性肝硬変,原発性胆汁性肝硬変(primary biliary cirrhosis; PBC),肝外門脈閉塞症(extrahepatic portal obstruction; EHO)各1例(9%)であったのに対し,十二指腸静脈瘤ではHCV,アルコール各3例(43%),EHO 1例(14%)とアルコール性が直腸静脈瘤で少ない傾向がみられた.血行動態は直腸静脈瘤で2例が同定され,流入路は下腸間膜静脈,流出路は直腸静脈であった.十二指腸静脈瘤の流入路は下膵十二指腸静脈が3例,空腸静脈第1枝が2例で,流出路は性腺静脈が3例,左胃静脈1例であった.治療法は直腸では経過観察が7例,内視鏡的静脈瘤結紮術(endoscopic variceal ligation; EVL) 2例,EVL + 内視鏡的静脈瘤硬化療法(endoscopic injection sclerotherapy; EIS),経皮経肝静脈瘤閉塞術(percutaneous transhepatic obliteration; PTO) 各1例,十二指腸では経過観察,EIS,EVL + EIS,EVL + PTO,バルーン閉塞下逆行性静脈瘤閉塞術(balloon-occluded retrograde transvenous obliteration; B-RTO),EIS + dual balloon occluded embolization; DBOE,プロプラノロール投与各1例と多彩であった.直腸静脈瘤と十二指腸静脈瘤の3年生存率はおのおの36%,83%で十二指腸静脈瘤は直腸静脈瘤に対して有意に生存期間が長かった(p < 0.05).肝癌合併例の3年生存率は17%,非合併例は74%で,肝癌の合併は異所性静脈瘤の生存期間を短縮することが示された(p < 0.05).異所性静脈瘤の死因は肝不全が6例,出血と肝癌がおのおの2例ずつであった.当病院群における過去8年間の異所性静脈瘤の発生部位は直腸静脈瘤と十二指腸静脈瘤で,基礎疾患,血行動態,治療法において差異がみられた.
Journal
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- Japanese Journal of Portal Hypertension
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Japanese Journal of Portal Hypertension 15 (2), 195-201, 2009
The Japan Society for Portal Hypertension
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Details 詳細情報について
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- CRID
- 1390001204479854976
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- NII Article ID
- 130001922330
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- ISSN
- 21866376
- 13448447
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- Text Lang
- ja
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- Data Source
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- JaLC
- CiNii Articles
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- Abstract License Flag
- Disallowed