Yachha S K, Dhiman R K, Gupta R, Ghoshal U C
Department of Gastroenterology (Pediatric GE Section), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Pediatr Gastroenterol Nutr. 1996 Nov;23(4):438-41. doi: 10.1097/00005176-199611000-00014.
Rectal endoscopic ultrasonography (REUS) was performed using an Olympus EU-M3 ultrasound fiberscope in 25 children with extrahepatic portal venous obstruction (median age of 8, range 3-16 years) and in eight control subjects (median age of 8, range 6-13). Rectal varices (tortuous or nodular distended veins seen beneath the mucosa) and portal hypertensive rectopathy were diagnosed endoscopically. At rectal endosonography, rectal varices were seen as rounded, oval, or longitudinal echo-free structures in the submucosa. Perirectal veins outside the rectal wall were also seen in REUS. Portal hypertensive rectopathy was endoscopically observed in nine (36%) patients. Rectal varices were detected by endoscopy in nine (36%) and by endosonographic examination in 19 (76%) patients with extrahepatic portal venous obstruction. The number (2, range 0-10) and size (3, range 0-4.5 mm) of submucosal veins seen on endosonography in patients were greater than in controls (0, range 0-1, and 0, range 0-2 mm; p < 0.001 for both). The size of perirectal veins was greater in patients than in controls (3.5, range 3-5 mm versus 2.5, range 2-3 mm; p < 0.001). Communicating veins between the submucosal and perirectal veins were seen in nine (36%) patients. Rectal endoscopic ultrasonography was superior to endoscopy in detecting the presence of rectal varices (76% versus 35%, p < 0.005). Our study suggests that endosonography is useful in detecting changes in the rectal and perirectal vasculature in patients with extrahepatic portal venous obstruction.
使用奥林巴斯EU-M3超声纤维镜对25例肝外门静脉阻塞患儿（中位年龄8岁，范围3 - 16岁）和8例对照者（中位年龄8岁，范围6 - 13岁）进行直肠内镜超声检查（REUS）。通过内镜诊断直肠静脉曲张（黏膜下可见迂曲或结节状扩张静脉）和门静脉高压性直肠病。在直肠超声检查中，直肠静脉曲张表现为黏膜下层圆形、椭圆形或纵向无回声结构。在REUS中还可见直肠壁外的直肠周围静脉。9例（36%）患者经内镜观察到门静脉高压性直肠病。在肝外门静脉阻塞患者中，9例（36%）通过内镜检测到直肠静脉曲张，19例（76%）通过超声检查检测到。患者超声检查所见黏膜下静脉数量（2条，范围0 - 10条）和大小（3mm，范围0 - 4.5mm）均大于对照者（0条，范围0 - 1条，0mm，范围0 - 2mm；两者p均<0.001）。患者直肠周围静脉大小大于对照者（3.5mm，范围3 - 5mm对2.5mm，范围2 - 3mm；p<0.001）。9例（36%）患者可见黏膜下静脉与直肠周围静脉之间的交通静脉。直肠内镜超声检查在检测直肠静脉曲张方面优于内镜检查（76%对35%，p<0.005）。我们的研究表明，超声检查有助于检测肝外门静脉阻塞患者直肠和直肠周围血管系统的变化。
