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单纯内镜下食管静脉曲张硬化剂注射及套扎术后血胸

Hemothorax following Uncomplicated Endoscopic Variceal Sclerotherapy and Ligation for Esophageal Varices.

作者信息

Ochiai Tomoko, Nakade Yukiomi, Kitano Rena, Kato Shunsuke, Sakamoto Kazumasa, Inoue Tadahisa, Kobayashi Yuji, Ishii Norimitsu, Ohashi Tomohiko, Sumida Yoshio, Ito Kiyoaki, Nakao Haruhisa, Furuta Chihiro, Yano Motoki, Yoneda Masashi

机构信息

Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.

Division of Thoracic Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan.

出版信息

Case Rep Gastroenterol. 2017 Sep 15;11(3):531-538. doi: 10.1159/000480378. eCollection 2017 Sep-Dec.

Abstract

Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures. An 86-year-old man diagnosed with liver cirrhosis due to chronic hepatitis type B and alcohol abuse underwent variceal sclerotherapy using ethanolamine oleate to treat his esophageal varices. Oozing from the esophageal varices continued even after the sclerotherapy procedure; therefore, we performed endoscopic variceal ligation. The patient developed left-sided hemothorax within 24 h after treatment of his varices, and an emergency thoracotomy was performed. A pulmonary ligament of the left lung was bulging and ripping because of mediastinal hematoma, and oozing was noted. Cessation of bleeding was noted after the laceration of the left pulmonary ligament had been sutured. Ours is the first case of hemothorax reported in a patient following an uncomplicated procedure of sclerotherapy and ligation.

摘要

内镜下静脉曲张硬化治疗和套扎术是用于治疗食管静脉曲张的标准治疗方式。据报道,硬化治疗和套扎术会引发诸如血尿、肺血栓形成、胸腔积液、肾功能障碍以及食管狭窄等并发症。然而,硬化治疗和套扎术后发生血胸的情况尚未见报道。我们治疗了一名患有肝硬化和真性红细胞增多症的患者,该患者在上述治疗后出现了血胸。一名86岁男性因慢性乙型肝炎和酒精滥用被诊断为肝硬化,采用油酸乙醇胺进行食管静脉曲张硬化治疗。即便在硬化治疗术后,食管静脉曲张仍持续渗血;因此,我们又实施了内镜下静脉曲张套扎术。该患者在静脉曲张治疗后24小时内出现左侧血胸,并接受了急诊开胸手术。由于纵隔血肿,左肺肺韧带膨出并撕裂,可见渗血。在缝合左肺韧带撕裂处后出血停止。我们报道的这例血胸是首例在硬化治疗和套扎术过程顺利的患者中出现的病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/de82/5636992/228ee6864852/crg-0011-0531-g01.jpg

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