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Stomach and Intestine(Tokyo) Volume 20, Issue 5 （May 1985）

胃と腸 20巻5号（1985年5月発行）

Japanese English

今月の主題食道静脈瘤の硬化療法

主題

食道静脈瘤の内視鏡的硬化療法―その実際と予後 Endoscopic Sclerotherapy for Esophageal Varices, Its Practice and Prognosis 鈴木博昭 ¹ , 稲垣芳則 ¹ , 神山正之 ¹ , 三穂乙実 ¹ , 渡辺豊 ¹ , 長尾房大 ¹ Hiroaki Suzuki ¹ , Yoshinori Inagaki ¹ , Masayuki Kohyama ¹ , Otomi Miho ¹ , Yutaka Watanabe ¹ , Fusahiro Nagao ¹ ¹東京慈恵会医科大学第2外科 ¹The Second Department of Surgery, The Jikei University, School of Medicine pp.489-495

発行日 1985年5月25日 Published Date 1985/5/25

DOI https://doi.org/10.11477/mf.1403109819

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要旨　食道静脈瘤例の緊急止血および出血予防と静脈瘤の荒廃を目的として138例434回の内視鏡的硬化療法を施行した．手技は1％Aethoxysklerolの静脈瘤外および内の併用注入法である．緊急内視鏡時に活動性出血を示したのが23例あった（噴出性出血は9例）が，20例の止血に成功し，87％の止血率であった．硬化療法後の静脈瘤の縮小，消失（荒廃）は89％の症例（78/88）に認められた．特にF₁以下まで荒廃された症例（68例）では再出血は4例（6％）と低率であった．硬化療法後の累積生存率は，手術適応基準内の58例では1年97％，2年94％，3年87％，5年82％であり，手術不能と判定された62例では1年56％，2年32.8％，3年12.8％であった．

　Since March 1979 we have actively practiced endoscopic sclerotherapy for esophageal varices.

　Materials and Methods: We have performed 434 endoscopic sclerotherapies on 138 patients with esophageal varices. There were 56 cases of acute bleeding and 82 cases with or without bleeding episodes. We selected 1% Aethoxysklerol (Kreussler Co.) as the safest sclerosant. It was injected araund the varices and then into the varices. The sclerotherapy was performed three times in a series with one week intervals and the follow-up was made every three months for observation or for repeat treatment if necessary.

　Results: 1) Among 56 cases of acute bleeding, emergency endoscopy showed active bleeding in 23 cases (flush bleeding in 9 cases and oozing bleeding in 14 cases). Bleeding was stopped by sclerotherapy in 20 cases or 87%. 2) We consider sclerotherapy not only to have a hemostatic effect but also to eradicate the varices in many cases. Among 88 cases followed-up for more than three months after the first sclerotherapy, esophageal varices diminished or were even eradicated in 78 cases or 89%. Rebleeding occurred only very occasionally (6%) in such successful cases. 3) Autopsy cases (5 cases) suggested to us a mechanism of hemostasis and prophylaxis of bleeding in cases of esophageal varices following endoscopic sclerotherapy. 4) Long term follow-up studies showed us that three-year cumulative survival rate was 87% in cases of Child A and B, and 12.8% in cases of Child C.

　Conclusion: We can say that the endoscopic sclerotherapy by para- and intra-variceal injection of 1% Aethoxysklerol which we are performing is an excellent non-surgical treatment for bleeding from esophageal varices and also an effective method to eradicate them.