肠道异位静脉曲张37例

Ectopic varices in the gastrointestinal tract:an analysis of 37 cases

目的:探讨肠道异位静脉曲张(EV)的发病、病因及其与门脉高压(PH)的关系.方法:回顾性分析肠道EV37例.其诊断方法:内镜26例,经颈静脉肝内门体系统支架分流术(TIPSS)中行门脉造影10例,经皮肝穿刺肠系膜血管造影1例.PH的判断:肝硬化(HC)须有门脉增宽,非HC须有肝外门脉梗阻(EPVO)影像证据.TIPSS术中于门脉主干测压.结果:2003-05/2010-1228967例次内镜检查中查出肠EV26例(检出率为0.09%),282例TIPSS术中行门脉造影检出肠EV10例(检出率为3.5%).EV分布:十二指肠6例(球部2例、降部4例),小肠11例(空肠6例、回肠5例),结肠4例,肛直肠16例.TIPSS术中测门脉压力为3.18-6.13kPa(4.07kPa±0.92kPa).PH的病因:HC并PH26例(肝炎后19例,酒精性5例,胆汁性2例;3例伴有门脉血栓形成,9例食管曲张静脉硬化剂治疗史);EPVO4例(结肠癌术后2例,胰腺癌晚期1例,肠系膜血管瘤手术后1例);病因不明7例,均无HC、EPVO及PH的表现(其中2例作超声与CT检查,其余5例未作进一步检查).结论:肠道EV少见,以十二指肠、结肠及肛直肠等处好发;PH是EV的根本原因,为HC和EPVO所致;EV与PH都易漏诊,EV发生时PH表现可能不明显.

AIM： To investigate the incidence and causes of ectopic varices （EV） in the gastrointestinal tract and to analyze the relationship between EV and portal hypertension （PH）. METHODS： The clinical data for 37 patients with EV in the gastrointestinal tract were retrospectively analyzed. Of these patients, 26 were diagnosed by endoscopic examination, 10 during transjugular intrahepatic portosystemic stent shunt （TIPSS） procedures, and one by percutaneous transhepatic inferior mesenteric venography. The diagnosis of PH was based upon the finding of portal vein dilatation in patients with hepatic cirrhosis （HC） and extrahepatic portal vein obstruction （EPVO） in patients without cirrhosis. Portal pressure was measured directly in patients who underwent TIPSS. RESULTS： Patients with EV in the gastrointestinal tract were infrequently seen, representing 0.09% （26/28 967） of all patients undergoing endoscopic examination. Of all 37 cases of EV in the gastrointestinal tract, 6 occurred in the duodenum, 11 in the small intestine, 4 in the colon, and 16 in the anorectal region. In patients undergoing TIPSS, portal pressure ranged between 3.18 and 6.13 kPa, with a mean value of 4.07 kPa ± 0.92 kPa. The etiology of PH was HC in 26 cases and EPVO in 4 cases. In the remaining 7 cases, a specific cause had not been determined. CONCLUSION： EV in the gastrointestinal tract is a rare condition, occurring most commonly in the duodenum, colon, and anorectal region. PH is the primary cause of EV, often resulting from HC and EPVO. Both EV and PH may be easily overlooked, and EV may occur in patients lacking the classic signs of PH.