血行動態の解析によりEVL併用EISが有効であった出血性直腸静脈瘤の1例  [in Japanese] A case report of the successful treatment by combined EVL and EIS following the evaluation of the hemodynamics of rectal varices using arterial portography  [in Japanese]

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Abstract

症例は,75歳,男性.C型肝硬変症,肝細胞癌(HCC)にて当院通院中.2008年3月より血便を生じ,下部消化管内視鏡検査にて出血性直腸静脈瘤と診断.2008年7月HCCの治療目的にて入院.HCC治療時の上腸間膜動脈・脾動脈造影門脈相では遠肝性側副血行路は認めず,下腸間膜動脈造影にて下腸間膜動脈は直腸壁を造影し,その後排血路の一部として直腸静脈瘤が造影され下腸間膜静脈より脾静脈へと排血されていた.その後,直腸静脈瘤に対して内視鏡的静脈瘤結紮術(EVL)・硬化療法(EIS)併用療法を施行.直腸静脈瘤の口側端で,腸管壁外へ流出すると考えられた部位へEVL施行後,透視下でEISを施行.その後,造影CTにて直腸静脈瘤の血流は消失した.本症例は,血管造影にて直腸静脈瘤の血行動態を把握後にEVL・EIS併用療法を施行する事によって安全に治療しえた1例であったので報告する.<br>

A 75-year-old man has been followed up at our outpatient clinic for liver cirrhosis and hepatocellular carcinoma (HCC) caused by chronic hepatitis C virus infection. He had hematochezia found on March 2008, and subsequent colonoscopy identified the bleeding from rectal varices. In July 2008, he admitted to our hospital for the treatment of HCC. Portography via superior mesenteric and splenic artery was performed during the treatment, and no hepatofugal flow was detected. Instead, inferior mesenteric arterial portography revealed that inferior mesenteric artery feeded rectum, and visualized rectal varices, then outflow from inferior mesenteric vein to splenic vein as a drainage route. Thereafter we performed the combinational treatment with both endoscopic varices ligation (EVL) and endoscopic injection sclerotherapy (EIS). In details, we first operated EVL targeted the possible site for the out-wall flow of rectum at the oral edge of rectal varices, followed by the EIS under radiographical guidance. Subsequent contrast-enhanced CT confirmed the disappearance of the flow of the rectal varices. This case represented the successful treatment strategy of combined EVL and EIS following the evaluation of the hemodynamics of rectal varices using arterial portography.<br>

Journal

  • Kanzo

    Kanzo 51(2), 84-91, 2010-02-25

    The Japan Society of Hepatology

References:  23

Cited by:  1

Codes

  • NII Article ID (NAID)
    10026101277
  • NII NACSIS-CAT ID (NCID)
    AN00047770
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    04514203
  • NDL Article ID
    10575281
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-130
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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