Matsumoto H, Matsumoto M, Nemoto M, Suzuki F, Souda K, Kitahara H, Kobayashi Y, Tsugiki M, Kawasaki T, Kanai K
Second Department of Medicine, University of Hamamatsu School of Medicine.
Nihon Shokakibyo Gakkai Zasshi. 1994 Oct;91(10):1921-8.
Endoscopic intravariceal injection sclerotherapy (EIS) using sclerosant mixed with contrast medium was done in 100 patients without hepatocellular carcinoma. They were followed longer than 12 months (mean; 58 +/- 29 months) after EIS. The recurrence rate of esophageal varices in cases with complete eradication (n = 79) and cases with incomplete eradication of (n = 21) was 8.9% and 85.7%, respectively (p < 0.01). In 21 cases, complete eradication was achieved by intravariceal injection and additional therapy using paravariceal injection was not performed. The recurrence rate of this group was only 4.8%. Endoscopic varicealography during injection sclerotherapy were evaluated in 91 cases. At final session of EIS, narrowing of diameter (less than 1 mm) and irregularity of vessel walls were observed in small vessels (devastated vessels). Appearance rate of devastated vessel in 75 cases with completely eradicated esophageal varices was 65.3%. In contrast, among 16 cases with incomplete eradication of varices, devastated vessels were seen only in 6.3% (p < 0.01). It is concluded that the important point in preventing the recurrence of esophageal varices after EIS was the complete eradication of esophageal varices by intravariceal injection sclerotherapy resulting in the eradication of the routes to esophageal varices from port-splenic venous system. For the sake of accomplishment of this treatment, appearance of devastated vessel is very useful.
对100例无肝细胞癌的患者进行了内镜下曲张静脉内注射硬化剂治疗（EIS），所用硬化剂与造影剂混合。EIS术后对他们进行了超过12个月（平均58±29个月）的随访。食管静脉曲张完全消除的病例（n = 79）和未完全消除的病例（n = 21）中，食管静脉曲张的复发率分别为8.9%和85.7%（p<0.01）。在21例患者中，通过曲张静脉内注射实现了完全消除，未进行曲张静脉旁注射的额外治疗。该组的复发率仅为4.8%。对91例硬化剂注射治疗期间的内镜下曲张静脉造影进行了评估。在EIS的最后阶段，在小血管（破坏血管）中观察到直径变窄（小于1mm）和血管壁不规则。75例食管静脉曲张完全消除的病例中破坏血管的出现率为65.3%。相比之下，在16例静脉曲张未完全消除的病例中，仅6.3%可见破坏血管（p<0.01）。得出结论，EIS后预防食管静脉曲张复发的要点是通过曲张静脉内注射硬化剂完全消除食管静脉曲张，从而消除门静脉-脾静脉系统通向食管静脉曲张的途径。为了完成这种治疗，破坏血管的出现非常有用。
