Nakamura H, Inoue H, Kawano T, Goseki N, Endo M, Sugihara K
First Department of Surgery, Tokyo Medical and Dental University, Japan.
Surg Endosc. 1992 Sep-Oct;6(5):228-34. doi: 10.1007/BF02498809.
In 57 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and the esophagus by endoscopic ultrasonography (EUS). Variously developed intra- and extramural vascular structures had a relationship to the endoscopic variceal form, and communicating (inflow) vessels to varices were found in 28 of the 43 primary cases treated (65%). We then classified the esophagogastric varices into three types according to the vascular structure, such as the esophageal type, esophagogastric type, and solitary gastric type. Based on the analysis of these collateral structures, we selected the treatment as follows. In the esophageal type, which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophagogastric type, which has many enlarged inflow vessels, the Hassab operation is effective in devascularizing the extramural inflow vessels, and the combination of EIS is necessary to sclerose the intramural varices. In the solitary gastric type, which is a part of the downward portosystemic shunt, the Hassab operation is recommended to prevent rupture of the varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without.
在57例门静脉高压症患者中，我们通过内镜超声检查（EUS）研究了胃和食管的壁内及壁外结构。壁内和壁外不同程度发育的血管结构与内镜下静脉曲张形态有关，在43例接受治疗的原发性病例中，有28例（65%）发现了与静脉曲张相通的（流入）血管。然后，我们根据血管结构将食管胃静脉曲张分为三种类型，即食管型、食管胃型和孤立胃型。基于对这些侧支结构的分析，我们选择如下治疗方法。在流入血管较少的食管型中，通过内镜注射硬化疗法（EIS）闭塞流入血管很容易消除静脉曲张。在流入血管较多的食管胃型中，Hassab手术对壁外流入血管去血管化有效，而EIS联合使用对于硬化壁内静脉曲张是必要的。在作为下行门体分流一部分的孤立胃型中，对于有壁内走行血管的亚型，建议行Hassab手术以防止静脉曲张破裂，但对于没有壁内走行血管的亚型，保守治疗就足够了。
