CAJ | 학술논문

目的探讨胃肠道异位静脉曲张(ectopic varices,EV)的发病情况、病因、临床特点及治疗.方法解放军总医院2004年1月-2012年10月间经内镜检查的99 783例患者中检出胃肠道EV 64例,对其临床资料进行回顾性分析并结合文献进行复习.结果 EV检出率为0.06％(64/99 783).EV在胃肠道的分布:胃窦5例,十二指肠37例(降部24例,球部13例),结肠2例,直肠17例,回肠末端及全结直肠1例,吻合口2例.EV病因:肝硬化并门静脉高压52例(肝炎性42例、酒精性5例、胆汁性3例、不明原因肝硬化2例,25例有食管胃底曲张静脉硬化剂、组织胶或套扎治疗史),肝外门静脉梗阻4例(胰头癌1例,贲门癌术后1例,胰腺癌术后1例,小肠部分切除术后1例),病因不明8例.EV内镜下组织胶注射治疗9例(6例EV破裂出血经治疗后未再出血、3例EV消失),内镜下套扎治疗1例.结论 EV发生率较低,主要位于肠道,以十二指肠、结肠及直肠等处好发；门静脉高压是EV的主要发病原因,临床表现主要为消化道出血.门静脉高压患者发生不明原因消化道出血时应考虑到有EV可能.内镜下组织胶注射治疗EV取得良好疗效.
목적 탐토위장도이위정맥곡장(ectopic varices,EV)적발병정황、병인、림상특점급치료.방법 해방군총의원2004년1월-2012년10월간경내경검사적99 783례환자중검출위장도EV 64례,대기림상자료진행회고성분석병결합문헌진행복습.결과 EV검출솔위0.06％(64/99 783).EV재위장도적분포:위두5례,십이지장37례(강부24례,구부13례),결장2례,직장17례,회장말단급전결직장1례,문합구2례.EV병인:간경화병문정맥고압52례(간염성42례、주정성5례、담즙성3례、불명원인간경화2례,25례유식관위저곡장정맥경화제、조직효혹투찰치료사),간외문정맥경조4례(이두암1례,분문암술후1례,이선암술후1례,소장부분절제술후1례),병인불명8례.EV내경하조직효주사치료9례(6례EV파렬출혈경치료후미재출혈、3례EV소실),내경하투찰치료1례.결론 EV발생솔교저,주요위우장도,이십이지장、결장급직장등처호발；문정맥고압시EV적주요발병원인,림상표현주요위소화도출혈.문정맥고압환자발생불명원인소화도출혈시응고필도유EV가능.내경하조직효주사치료EV취득량호료효.
Objective To understand the incidence,causes,clinical manifestations and treatment of ectopic varices (EV) in gastrointestinal (GI)tract.Methods GI endoscopic examinations were carried out in 99 783 patients from January 2004 to October 2012 in General Hospital of PLA.Sixty-four cases of ectopic varices in GI tract were discovered.The clinical manifestations of EV patients and treatment were analyzed retrospectively.The literatures of EV were reviewed.Results The prevalence of EV in GI was 0.06％ (64/99 783) in all patients undergoing endoscopic examinations,including 5 in the gastric antrum,37 in the duodenum,2 in the colon,17 in the rectum,1 in terminal ileum as well as whole colorectum,and 2 in the anastomotic stomas.The causes of EV included portal hypertension with cirrhosis in 52 cases (42 of hepatitis as dominant,5 of alcoholic,3 of biliary).Twenty-five cases had past history of endoscopic sclerotherapy,tissue adhesive injection or band ligation.Extrahepatic portal vein obstruction was seen in 4 cases(1 with pancreatic cancer,gastric cardia after surgery,pancreatic cancer after surgery,small intestine after partial hepatectomy respectively)and 8 cases uncertain.Nine cases accepted endoscopic tissue adhesive injection (no post-operative hemorrhage occurred in 9 cases and EV disappeared in 3 cases).Endoscopic band ligation was performed only for one patient.Conclusions EV in GI tract is a rare condition,which occurs commonly in duodenum,colon,and rectum.Portal hypertension is the most common cause.Gastrointestinal hemorrhage is the main clinical manifestation.EV should be considered in GI bleeding,with gastroesophageal varices hemorrhage excluded.Endoscopic adhesive injection is an effective way to treat EV.