剖検例からみた食道静脈瘤硬化療法

Evaluation of Endoscopic Injection Sclerotherapy for Esophageal Varices from the Study of Twelve Autopsy Cases

要旨　内視鏡を用いて食道静脈瘤内に直接塞栓凝固剤を注入する食道硬化療法を施行後，何らかの原因で死亡した剖検例12例について検討した．エタノールアミンが静脈瘤内に十分量注入された症例では，粘膜下層の静脈瘤の完全な消失がみられた．しかし，長期経過観察例では粘膜下層の静脈が消失しても粘膜固有層に新たな拡張した静脈の出現がみられた．一方，エタノールアミンが適確に静脈瘤内に注入されずparavascularに注入された症例ではUl-Ⅲ～Ⅳの深い潰瘍を形成し，その潰瘍の変化は通常の食道潰瘍に比し，広範囲で炎症細胞浸潤も強かった．

　Autopsies and histopathological studies were performed in 12 patients with esophageal varices treated by sclerotherapy using 5% ethanolamine oleate, and the following results were obtained.

　(1) Esophageal varices were eradicated completely when scierosant was injected suffciently into the varices of the submucosal layer. In cases followed up for a long time, however, new varices developed in the proper mucosal layer even if those of the submucosal layer had diappeared.

　(2) Paravasal injection of 5% ethanolamine oleate caused deep ulcers (Ul-Ⅲ～Ⅳ) from which bleeding occurred occasionally. Ulcers caused by 5% ethanolamine oleate were more extensive and exhibited much more inflammatory cell-infiltration than ordinary esophageal ulcers.