Mathur S K, Vora I M, Supe A N, Plumber S T, Naik S R
Department of Surgery, Seth G S Medical College, Parel, Bombay.
Indian J Gastroenterol. 1990 Jul;9(3):213-5.
Autopsy studies have shown that a majority of sclerosants presently used for endoscopic variceal sclerotherapy achieve their end result by a process of necrotizing inflammation of the esophageal wall followed by fibrosis and thrombosis, rather than bland thrombosis of varices. We have been using 3% phenol in water for variceal sclerotherapy and found it to be an effective sclerosant. To study the effect of this sclerosant on varices and the esophageal wall, autopsies were performed in 15 patients who died following sclerotherapy. Histopathological examination of sections from the esophagus showed (a) fresh thrombus in the varices immediately following injection, (b) intimal damage with medial sclerosis and superficial mucosal ulceration after one week, (c) organisation and recanalization with marked medial sclerosis at 3-4 weeks, and (d) complete obliteration of varices after 6-12 weeks. None of the patients was found to have esophageal necrosis, perforation or mediastinitis. Thus, 3% aqueous phenol appears to be an effective and safe sclerosant for variceal sclerotherapy.
尸检研究表明，目前用于内镜下静脉曲张硬化治疗的大多数硬化剂，其最终效果是通过食管壁坏死性炎症、随后纤维化和血栓形成的过程实现的，而不是单纯的静脉曲张血栓形成。我们一直在使用3%的水合苯酚进行静脉曲张硬化治疗，并发现它是一种有效的硬化剂。为了研究这种硬化剂对静脉曲张和食管壁的影响，对15例硬化治疗后死亡的患者进行了尸检。食管切片的组织病理学检查显示：(a)注射后立即在静脉曲张内出现新鲜血栓；(b)一周后内膜损伤伴中层硬化和浅表黏膜溃疡；(c) 3 - 4周时血栓机化再通，中层硬化明显；(d) 6 - 12周后静脉曲张完全闭塞。未发现患者有食管坏死、穿孔或纵隔炎。因此，3%水合苯酚似乎是一种用于静脉曲张硬化治疗的有效且安全的硬化剂。
