Hashizume M, Tanoue K, Ohta M, Ueno K, Sugimachi K, Kashiwagi M, Sueishi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Am J Gastroenterol. 1993 Nov;88(11):1942-5.
Duodenal varices are a rare occurrence, and the diagnosis and control of related bleeding is problematic. The vascular anatomy of duodenal varices in four patients was examined angiographically. The incidence of these varices was 0.4% in the patients with portal hypertension seen in our clinics from 1982 to 1991. The transparent specimen obtained at autopsy and treated with methyl salicylate and portographies in the remaining three patients revealed that the duodenal varix consisted of a single vessel with afferent and efferent vessels, forming a portasystemic shunt in the retroperitoneum. The varix transversed the duodenum and was present in the submucosal layer of the posterior wall. The afferent vessel was the superior or inferior pancreaticoduodenal vein originating in the portal vein trunk or superior mesenteric vein. The efferent vein drained into the inferior vena cava. In view of these observations, devascularization or percutaneous transhepatic obliteration of the varix would be our first choice of treatment for patients with duodenal varices.
十二指肠静脉曲张较为罕见，其相关出血的诊断和控制存在问题。对4例患者的十二指肠静脉曲张进行了血管造影检查。在1982年至1991年期间，我院门诊所见门静脉高压患者中，这些静脉曲张的发生率为0.4%。对其余3例患者尸检获得的透明标本用冬青油处理，并进行门静脉造影，结果显示十二指肠静脉曲张由一条带有输入和输出血管的单一血管组成，在腹膜后形成门体分流。该静脉曲张横过十二指肠，位于后壁的黏膜下层。输入血管为起源于门静脉主干或肠系膜上静脉的胰十二指肠上静脉或下静脉。输出静脉汇入下腔静脉。鉴于这些观察结果，对于十二指肠静脉曲张患者，去血管化或经皮肝穿刺闭塞静脉曲张将是我们的首选治疗方法。
