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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.
Objective: To investigate the etiology and pathogenesis of intestinal ectopic varicocele (EV) and its relationship with portal hypertension (PH) .Methods: A retrospective analysis of intestinal EV37 cases.Its diagnostic method: endoscopic 26 cases, via the jugular vein Intrahepatic portosystemic stent shunt (TIPSS) in the portal vein angiography in 10 cases, percutaneous transhepatic mesenteric angiography in 1. PH judgment: liver cirrhosis (HC) should be widened portal vein, non-HC must have extrahepatic Portal vein obstruction (EPVO) imaging evidence.TIPSS intraoperative portal pressure measurements.Results: 2003-05 / 2010-1228967 cases of endoscopic examination found intestinal EV26 cases (detection rate of 0.09%), 282 cases TIPSS intraoperative portal vein angiography detected EV10 cases (detection rate was 3.5%) EV distribution: duodenum in 6 cases (2 cases of ball, descending 4 cases), 11 cases of small intestine (6 cases of jejunum, ileum 5 cases), 4 cases of colon and 16 cases of anorectal .Tips pressure measured during TPSS was 3.18-6.13kPa (4.07kPa ± 0.92kPa) .The causes of PH were 26 cases of HC and PH (19 cases after hepatitis and 5 cases of alcoholic 2 cases of biliary disease, 3 cases of portal vein thrombosis and 9 cases of history of esophageal variceal vein hardening therapy); 4 cases of EPVO (2 cases of postoperative colon cancer, 1 case of advanced pancreatic cancer, 1 case of mesentery hemangioma after operation) ); Etiology of unknown 7 cases, no HC, EPVO and PH performance (of which 2 Cases of ultrasound and CT examination, the remaining 5 patients without further examination.) Conclusion: EV intestinal rare, with duodenum, colon and anorectal good hair; PH is the root cause of EV for the HC and EPVO To; EV and PH are easily missed diagnosis, PH performance may not be obvious EV.