Takasaki M, Takahashi I, Takamatsu M, Yorimitsu S, Yorimitsu Y, Takeda I, Horimi T
Department of Gastroenterology, Kochi Municipal Central Hospital, Japan.
J Gastroenterol. 1996 Apr;31(2):260-2. doi: 10.1007/BF02389527.
A 74-year-old female with idiopathic myelofibrosis (IMF) was admitted to our hospital because of massive hematemesis and melena. Immediate upper gastrointestinal endoscopy revealed an intermittent spurting hemorrhage from extensive esophageal varices. Endoscopic injection sclerotherapy (EIS) was carried out and the bleeding ceased. After five courses of EIS, all the esophageal varices were eradicated. About 15 months later, the patient died, due to a cerebral hemorrhage, without further variceal bleeding. A postmortem examination was carried out and the portal hypertension was considered to be due not only to extramedullary hematopoiesis in the sinusoids, but also to increased splenic blood flow. We are confident that EIS is an effective therapeutic procedure for patients with IMF showing esophageal variceal hemorrhage. EIS should be the preferred choice of treatment for esophageal varices in patients with IMF, since it is less invasive than splenectomy.
一名74岁患有特发性骨髓纤维化（IMF）的女性因大量呕血和黑便入院。急诊上消化道内镜检查显示广泛食管静脉曲张有间歇性喷射性出血。进行了内镜注射硬化治疗（EIS），出血停止。经过五个疗程的EIS，所有食管静脉曲张均被根除。约15个月后，患者因脑出血死亡，未再发生静脉曲张出血。进行了尸检，门静脉高压被认为不仅是由于肝血窦内的髓外造血，还由于脾血流量增加。我们确信EIS对于出现食管静脉曲张出血的IMF患者是一种有效的治疗方法。EIS应成为IMF患者食管静脉曲张的首选治疗方法，因为它比脾切除术的侵入性小。
