Graeber G M, Ratner M H, Ackerman N B
Surgery. 1976 Jan;79(1):107-10.
Enterostomal varices have been recognized as a cause of serious recurrent hemorrhage in patients with portal hypertension secondary to cirrhosis. Most often the varices at the mucocutaneous junction are the source of the hemorrhage. Three patients--two with hemorrhages from ileostomies and one with hemorrhages from a colostomy--are presented. Local measures have proved successful in controlling hemorrhages. Occasionally direct pressure alone will prove sufficient; more often the bleeding varix will need ligation. Complete revision of the enterostomy under local anesthesia can effect total disruption of the protal-systemic shunt and temporarily can eliminate local hemorrhage. Surgically created portasystemic shunts may be considered in good risk patients in order to eliminate hemorrhage from the stomal varices. Palliative local measures, however, remain the treatment of choice in the high-risk, cirrhotic patient who is unlikely to survive a major operation.
肠造口静脉曲张已被确认为肝硬化继发门静脉高压患者严重复发性出血的一个原因。多数情况下，黏膜皮肤交界处的静脉曲张是出血源。本文报告了3例患者，其中2例回肠造口出血，1例结肠造口出血。已证明局部措施对控制出血有效。偶尔单纯直接压迫就足够了；但更多时候出血的静脉曲张需要结扎。在局部麻醉下对肠造口进行彻底修复可完全破坏门体分流，并可暂时消除局部出血。对于手术风险低的患者，可考虑手术建立门体分流以消除造口静脉曲张出血。然而，对于不太可能在大手术中存活的高危肝硬化患者，姑息性局部措施仍是首选治疗方法。
