腸管動静脈奇形―自験12例と本邦報告例の解析

Arteriovenous Malformation of the Intestine: Review of 230 Cases Reported in Japan

要旨　腸管動静脈奇形（AVM）の自験12例と文献報告例の解析を行い，本邦における腸管AVMの臨床像や画像所見の特徴を中心に検討した．主症状は，病変部からの反復する出血であり，時に大量でショック状態を来し，輸血が必要になる場合も多い．診断には選択的血管造影が有用であるが，大腸病変に対しては内視鏡検査の担う役割も大きい．治療は，外科的切除が原則であるが，重篤な合併疾患などにより手術が困難な場合は，血管カテーテルを用いた治療や内視鏡治療も積極的に行われている．人口の高齢化や欧米型腸疾患の増加などにより，本邦でも患者数の増加が見込まれ，原因不明の消化管出血をみた場合は，本症の存在も念頭に置いて検索を進める必要がある．

　The purpose of this study was to evaluate the clinical characteristics of arteriovenous malformation (A-V malformation) of the intestine in Japanese cases. We have encountered 12 cases of A-V malformations of the intestine, which were diagnosed by angiography. We had analyzed 230 cases, reported in Japanese medical literature, including our cases. The principal clinical symptom was repeated intestinal bleeding without abdominal pain. The common sites of A-V malformation of the bowel were the small intestine and the right side of the colon. Lesions in the small intestine were much more common in young cases under 60 years old, and lesion in the right side of the colon were common in elderly cases over 60 years old. The most reliable method for diagnosing this lesions is selective angiography, but colonoscopy is also a useful diagnostic tool especially for small colonic lesions. Most of the cases were treated by surgical resection, however angiographic interventions and colonoscopic treatment were effective for cases with severe systemic complications.