日本异位静脉曲张现状：日本门静脉高压学会调查结果。

Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension.

机构信息

Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan.

出版信息

Hepatol Res. 2010 Aug;40(8):763-76. doi: 10.1111/j.1872-034X.2010.00690.x.

DOI:10.1111/j.1872-034X.2010.00690.x

PMID:20649816

Abstract

AIM

The Clinical Research Committee of the Japan Society for Portal Hypertension has conducted a nationwide questionnaire survey to clarify the current status of ectopic varices in Japan.

METHODS

A total of 173 cases of ectopic varices were collected.

RESULTS

Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion. Conslusions: Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future.

摘要

目的

日本门脉高压症学会临床研究委员会开展了一项全国性问卷调查，以明确日本异位静脉曲张的现状。

方法

共收集到 173 例异位静脉曲张病例。

结果

发现十二指肠静脉曲张 57 例，多位于降部至横部；小肠静脉曲张 11 例，结肠静脉曲张 6 例；直肠静脉曲张 77 例，占比最大（44.5%）；其他部位静脉曲张有胆道、吻合口、造口和膈肌。引起异位静脉曲张的最常见疾病是肝硬化（80.3%）。值得注意的是，直肠静脉曲张患者常有食管静脉曲张病史（94.8%），并接受内镜治疗（87.0%）。异位静脉曲张的治疗方式紧急治疗占 46.5%，择期治疗占 35.4%，预防性治疗占 18.2%。在紧急情况下，内镜治疗最常见（67.4%），其次是介入放射学（IVR；15.2%），内镜-IVR 联合治疗（6.5%）。择期治疗采用内镜治疗 34.3%，IVR 治疗 28.6%，内镜-IVR 联合治疗 5.7%，手术治疗 25.7%。预防性治疗采用内镜治疗 50.0%，IVR 治疗 33.3%，联合治疗 11.1%，无预防性手术。治疗后静脉曲张的变化为消失 54.9%，残留 35.4%，复发 9.7%。直肠静脉曲张的消失率（40.8%）明显低于十二指肠静脉曲张（73.4%）。病变部位的患者结局无差异。结论：通过全国性问卷调查明确了日本异位静脉曲张的现状。作者希望进一步阐明异位静脉曲张的病理生理学，并在未来建立更好的诊断方法和治疗方法。