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

要旨　食道静脈瘤に対する内視鏡的硬化療法施行例の予後について，内視鏡的栓塞療法を施行した肝硬変症を原疾患とする食道静脈瘤症例231例（急性出血例34例，待期的治療例90例，予防的治療例107例）の生存期間，再発率および遠隔死因から検討した．その結果，本治療法後の食道静脈瘤出血率は3.0％（7/231）であり，本治療法後の予後は比較的良好であると思われた．しかし，再発率が10.8％（25/231）であるので，本治療法には長期的治療効果があるとは言い難いと思われた．本治療法では治療効果延長のための再治療は容易で，かつ遠隔死亡例の死因の中に本治療法が直接関与したものはないので，本治療法を食道静脈瘤の“分割治療法”と考えたい．

　Through Octcber 1977 to September 1984, 231 patients with esophageal varices and cirrhosis received injection sclerotherapy in our institute and affiliated hospitals. Of them 34 patients were emergency cases, 90 elective, and 107 prophylactic. All of them were followed up and the results were examined. One hundred and seventy patients are still alive, and six patients are still living more than five years after initial treatment. Sixty one patients died eventually because of hepatic failure, gastric bleeding, hepatocellular carcinoma and other causes. However, no patient died of injection sclerotherapy itself. The recurrence rate, defined as return to the same condition as before thet reatment, was 10.8% (25/231). Seven patients experienced bleeding from varices. On the basis of our study, we suggest that injection sclerotherapy is a highly recommended method for esophageal varices with cirrhosis.