Katz J A, Rubin R A, Cope C, Holland G, Brass C A
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia.
Am J Gastroenterol. 1993 Jul;88(7):1104-7.
Anorectal varices are portal-systemic collaterals commonly found in patients with portal hypertension. Although these varices rarely bleed, when bleeding does occur it may be massive and life threatening. Anorectal varices may be mistaken for hemorrhoids and there is no agreed upon method for their definitive diagnosis. Additionally, there is no standard therapy for bleeding anorectal varices, and when techniques designed for the control of hemorrhoidal bleeding are employed the results can be disastrous. We report here the first use of a transjugular intrahepatic portosystemic shunt (TIPS) for the permanent control of bleeding anorectal varices. Magnetic resonance imaging/magnetic resonance venography (MRI/V) was used as a non-invasive method for the identification of anorectal varices and to confirm the successful decompression of these varices with TIPS placement. MRI/V and TIPS may provide significant advances in the diagnosis and treatment of rectal variceal bleeding.
肛门直肠静脉曲张是门静脉系统的侧支循环，常见于门静脉高压患者。虽然这些静脉曲张很少出血，但一旦出血，可能量很大且危及生命。肛门直肠静脉曲张可能被误诊为痔疮，目前尚无公认的确诊方法。此外，对于出血性肛门直肠静脉曲张没有标准的治疗方法，采用控制痔疮出血的技术时，结果可能是灾难性的。我们在此报告首次使用经颈静脉肝内门体分流术（TIPS）来永久控制出血性肛门直肠静脉曲张。磁共振成像/磁共振静脉造影（MRI/V）被用作一种非侵入性方法来识别肛门直肠静脉曲张，并确认通过放置TIPS成功减压这些静脉曲张。MRI/V和TIPS可能在直肠静脉曲张出血的诊断和治疗方面取得重大进展。
