Toyonaga A, Iwao T, Sumino M, Takagi K, Oho K, Shigemori H, Tanikawa K
Department of Medicine II, Kurume University School of Medicine, Japan.
J Gastroenterol Hepatol. 1996 Dec;11(12):1110-4. doi: 10.1111/j.1440-1746.1996.tb01837.x.
We performed prophylactic sclerotherapy in 350 patients with 'high risk' oesophageal varices (F2 or F3 with a moderate or severe red colour sign). Of these patients, eight exhibited sclerotherapy resistance (i.e. no significant reduction in the size of varices after five sessions of sclerotherapy). Thus, the prevalence of sclerotherapy resistant varices was 2%. Of 350 patients, 97 underwent haemodynamic investigation before sclerotherapy. This group consisted of seven patients with sclerotherapy resistant varices and 90 patients with non-resistant varices. Portal pressure, assessed by portal venous pressure gradient, was similar in these two groups (21.5 +/- 4.8 vs 19.8 +/- 5.0 mmHg, respectively; NS). However, the prevalence of the 'pipe-line' form of variceal feeding pattern (a large dilated left gastric vein running up the oesophagus) was higher in patients with resistant varices than in those with non-resistant varices (100 vs 3%, respectively; P < 0.01) and the diameter of the left gastric vein was larger in patients with resistant varices than in those with non-resistant varices (12.4 +/- 2.0 vs 7.8 +/- 2.3 mm, respectively; P < 0.01). Moreover, the extravariceal portosystemic shunt was poorly developed in patients with resistant varices compared with non-resistant varices (0 vs 52%, respectively; P < 0.05). We conclude that the pipe-line pattern, fed by a large left gastric vein and associated with poorly developed extravariceal portosystemic shunt, is a distinctive portal venographic feature of sclerotherapy resistant varices.
我们对350例患有“高危”食管静脉曲张（F2或F3且伴有中度或重度红色征）的患者进行了预防性硬化治疗。在这些患者中，有8例表现出硬化治疗抵抗（即经过5次硬化治疗后静脉曲张大小无显著减小）。因此，硬化治疗抵抗性静脉曲张的患病率为2%。在350例患者中，97例在硬化治疗前接受了血流动力学检查。该组包括7例硬化治疗抵抗性静脉曲张患者和90例非抵抗性静脉曲张患者。通过门静脉压力梯度评估的门静脉压力在这两组中相似（分别为21.5±4.8 mmHg和19.8±5.0 mmHg；无显著性差异）。然而，抵抗性静脉曲张患者中静脉曲张供血模式的“管道样”形态（一条沿食管上行的粗大扩张的胃左静脉）的患病率高于非抵抗性静脉曲张患者（分别为100%和3%；P<0.01），且抵抗性静脉曲张患者的胃左静脉直径大于非抵抗性静脉曲张患者（分别为12.4±2.0 mm和7.8±2.3 mm；P<0.01）。此外，与非抵抗性静脉曲张患者相比，抵抗性静脉曲张患者的静脉曲张外门体分流发育不良（分别为0和52%；P<0.05）。我们得出结论，由粗大胃左静脉供血且伴有发育不良的静脉曲张外门体分流的管道样形态是硬化治疗抵抗性静脉曲张独特的门静脉造影特征。
