门静脉高压异位静脉曲张出血的临床诊治进展

doi:10.3969/j.issn.1004-583X.2024.06.011

摘要/Abstract

摘要：

异位静脉曲张(Ectopic varices, EcV)是指发生于食管胃底以外的门体侧支循环,主要与各种原因导致的门脉高压(Portal hypertension,PH)有关。EcV发生率低,但出血及死亡率高。EcV出血的治疗主要有药物、内镜、介入和外科手术等,常需多学科协作诊治。目前关于EcV多为个案报道,缺乏相关诊治指南,临床医师对其认知不足,造成诊治困难。本文就EcV的病因、发病机制、流行病学、诊断及治疗作一综述,以期为EcV的临床诊治提供参考。

中图分类号:

R543.6

陈晓天, 霍丽娟. 门静脉高压异位静脉曲张出血的临床诊治进展[J]. 临床荟萃, 2024, 39(6): 548-553.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.06.011

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I6/548

参考文献 48

[1]	Angelo C, Tan A, Halegoua-De Marzio D, et al. Hematuria leads to a new diagnosis of cirrhosis[J]. Case Rep Gastroenterol, 2022, 16(2):446-451. doi: 10.1159/000525403 pmid: 36157612
[2]	MacHugh PP, Jeon H, Gedaly R, et al. Vaginal varices with massive hemorrhage in a patient with nonalcoholic steatohepatitis and portal hypertension: Successful treatment with liver transplantation[J]. Liver Transpl, 2008, 14(10):1538-1540.
[3]	Bahdi F, George R, Patel K. EUS-guided coiling and cyanoacrylate injection of ectopic duodenal varices[J]. VideoGIE, 2020, 6(1):35-37.
[4]	Kothadia JP, Aleem A, Raza A. Ectopic duodenal varices in a noncirrhotic patient with inferior vena cava occlusion[J]. ACG Case Rep J, 2021, 8(8):e00653.
[5]	Sasaki T, Kanata R, Yamada I, et al. Improvement of treatment outcomes for metastatic pancreatic cancer: A real-world data analysis[J]. In Vivo, 2019, 33(1):271-276. doi: 10.21873/invivo.11471 pmid: 30587635
[6]	Smith JK, Gautam M, Wortley PG, et al. Ectopic vaginal varices with hemorrhage after hysterectomy[J]. ACG Case Rep J, 2022, 9(10):e00878.
[7]	Tanikawa T, Ishii K, Katsumata R, et al. Treatment of ectopic variceal bleeding at choledochojejunostomy by endoscopic glue injection therapy with cyanoacrylate: Report of three cases including long-term outcomes[J]. DEN Open, 2022, 2(1):e110.
[8]	Katakura K, Irisaw A, Obara K, et al. Appearance of rectal varices in extrahepatic portal obstruction after treatment for esophago gastric varices: A case report[J]. Fukushima J Med Sci, 2002, 48(1):51-56.
[9]	Sunkara T, Caughey ME, Culliford A, et al. Idiopathic isolated colonic varices: An extremely rare condition[J]. J Clin Med Res, 2018, 10(1):63-65. doi: 10.14740/jocmr3230w pmid: 29238436
[10]	Yipeng W, Cong L, Sizhe W, et al. Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: A systematic rEcView[J]. Eur J Gastroenterol Hepatol, 2021, 33(4):461-469.
[11]	Shigefuku R, Iwasa M, Yoshikawa K, et al. A rare presentation of intraperitoneal ectopic varices rupture[J]. Intern Med, 2021, 60(6):959-960.
[12]	Hatami B, Salarieh N, Ketabi Moghadam P, et al. Transverse colon varices[J]. Gastroenterol Hepatol Bed Bench, 2022, 15(2):184-187.
[13]	Helmy A, Al Kahtani K and Al Fadda M. Updates in the pathogenesis, diagnosis and management of ectopic varices[J]. Hepatol Int, 2008, 2(3):322-334. doi: 10.1007/s12072-008-9074-1 pmid: 19669261
[14]	De Palma DG, Rega M, Masone S, et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: A capsule endoscopy study[J]. Gastrointest Endosc, 2005, 62(4):529-534. doi: 10.1016/s0016-5107(05)01588-9 pmid: 16185966
[15]	Nakamura N, Suzuki R, Takahashi Y, et al. Percutaneous transhepatic obliteration for rupture of varices in the small intestine: A case report[J]. Clin J Gastroenterol, 2022, 15(5):890-894. doi: 10.1007/s12328-022-01660-2 pmid: 35776291
[16]	Etik D, Oztas E, Okten S, et al. Ectopic varices in portal hypertension: computed tomographic angiography instead of repeated endoscopies for diagnosis[J]. Eur J Gastroenterol Hepatol, 2011, 23(7):620-622.
[17]	Payne A, Than NN, Jalan R, et al. An unusual case of hematochezia[J]. Cureus, 2020, 12(7):e8957.
[18]	Minowa K, Komatsu S, Takashina K, et al. Ectopic gastrointestinal variceal bleeding with portal hypertension[J]. World J Gastrointest Surg, 2017, 9(12):288-292. doi: 10.4240/wjgs.v9.i12.288 pmid: 29359035
[19]	Gheorghiu AC, Proserpio M, Regusci L, et al. Ectopic varices masquerading as lower gastrointestinal bleeding[J]. BMJ Case Rep, 2019, 12(1):e227469.
[20]	Francois F, Tadros C, Diehl D. Pan-colonic varices and idiopathic portal hypertension[J]. J Gastrointestin Liver Dis, 2007, 16(3):325-328.
[21]	O'Neill RS, Wang WJ, Chan P, et al. An obscure cause of gastrointestinal bleeding: Recurrent duodenal variceal hemorrhage treated with intramuscular octreotide in the absence of portal hypertension[J]. JGH Open, 2022, 7(1):78-80.
[22]	Rana SS, Bhasin DK, Sharma V, et al. Clinical, endoscopic and endoscopic ultrasound features of duodenal varices: A report of 10 cases[J]. Endosc Ultrasound, 2014, 3(1):54-57. doi: 10.4103/2303-9027.121243 pmid: 24949411
[23]	McAvoy NC, PlEcVris JN, Hayes PC. Human thrombin for the treatment of gastric and ectopic varices[J]. World J Gastroenterol, 2012, 18(41):5912-5917.
[24]	Sistla SC, Karthikeyan VS, Ram D, et al. Endoscopic variceal ligation as a safe and effective alternative to endoscopic sclerotherapy in bleeding ectopic duodenal varix--report of a rare case[J]. Indian J Gastroenterol, 2013, 32(6):419-420. doi: 10.1007/s12664-012-0289-7 pmid: 23212743
[25]	Sato T, Y amazaki K, Toyota J, et al. The value of the endoscopic therapies in the treatment of rectal varices: A retrospective comparison between injection sclerotherapy and band ligation[J]. Hepatol Res, 2006, 34(4): 250-255. pmid: 16540369
[26]	Park SB, Lee SH, Kim JH, et al. Successful treatment of duodenal variceal bleeding by endoscopic clipping[J]. Clin Endosc, 2013, 46(4):403-406. doi: 10.5946/ce.2013.46.4.403 pmid: 23964340
[27]	Park CM, Shin WG, Hong KW, et al. Arteriovenous malformation causing ileocecal variceal bleeding in liver cirrhosis: Case report and rEcView of the literature[J]. Gut Liver, 2008, 2(1):54-59.
[28]	Palermo M, Santonocito S, Failla G, et al. Bleeding duodenal varices urgently treated with TIPS and coil embolization in a patient with cirrhosis: A rare case[J]. Radiol Case Rep, 2021, 16(6):1580-1585.
[29]	DinuAbirami P, Varghese J, Reddy MS. Ectopic stomal varices in chronic liver disease[J]. ACG Case Rep J, 2022, 9(3):e00751.
[30]	Kochar N, Tripathi D, McAvoy NC, et al. Bleeding ectopic varices in cirrhosis: the role of transjugular intrahepatic portosystemic stent shunts[J]. Aliment Pharmacol Ther, 2008, 28(3):294-303.
[31]	Anand R, Ali SE, Raissi D, et al. Duodenal variceal bleeding with large spontaneous portosystemic shunt treated with transjugular intrahepatic portosystemic shunt and embolization: A case report[J]. World J Radiol, 2019, 11(8):110-115. doi: 10.4329/wjr.v11.i8.110 pmid: 31523400
[32]	Stein DJ, Salinas C, Sabri S, et al. Balloon retrograde transvenous obliteration versus endoscopic cyanoacrylate in bleeding gastric varices: Comparison of rebleeding and mortality with extended follow-up[J]. J Vasc Interv Radiol, 2019, 30(2):187-194. doi: S1051-0443(18)31777-9 pmid: 30717949
[33]	Anan A, Irie M, Watanabe H, et al. Colonic varices treated by balloon-occluded retrograde transvenous obliteration in a cirrhotic patient with encephalopathy: A case report[J]. Gastrointest Endosc, 2006, 63(6):880-884. pmid: 16650568
[34]	Matsumoto K, Imai Y, Takano M, et al. A case of colonic varices complicated by alcoholic cirrhosis treated using balloon-occluded retrograde transvenous obliteration[J]. Clin J Gastroenterol, 2018, 11(5):343-347. doi: 10.1007/s12328-018-0857-1 pmid: 29696582
[35]	Liu C, Srinivasan S, Babu SB, et al. Balloon-occluded retrograde transvenous obliteration of colonic varices: A case report[J]. CVIR Endovasc, 2020, 3(1):17. doi: 10.1186/s42155-020-00108-3 pmid: 32173771
[36]	Copelan A, Chehab M, Dixit P, et al. Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: rEcView of 32 cases[J]. Ann Hepatol, 2015, 14(3):369-379.
[37]	Saad WE, Wagner CC, Lippert A, et al. Protective value of TIPS against the dEcVelopment of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration (BRTO)[J]. Am J Gastroenterol, 2013, 108(10): 1612-1619.
[38]	Ohs Z, Jones M, Sharma N, et al. Percutaneous transhepatic embolization of ectopic varices in a patient with portal hypertension presenting with hemorrhagic shock[J]. Cureus, 2021, 13(9):e18209.
[39]	Fukumoto G, Kimura H, Kanagaki M, et al. Intraabdominal hemorrhage from ruptured ectopic varices treated by antegrade embolization via a recanalized paraumbilical vein[J]. Cardiovasc Intervent Radiol, 2019, 42(8):1204-1207. doi: 10.1007/s00270-019-02235-4 pmid: 31073821
[40]	Ono Y, Kariya S, Nakatani M, et al. Balloon-occluded antegrade transvenous sclerotherapy to treat rectal varices: A direct puncture approach to the superior rectal vein through the greater sciatic foramen under CT fluoroscopy guidance[J]. Cardiovasc Intervent Radiol, 2015, 38(5):1320-1324. doi: 10.1007/s00270-015-1174-4 pmid: 26163363
[41]	Shi Q, Zhou C, Liu J, et al. Transjugular intrahepatic portosystemic shunt for repeated bleeding of hemorrhoids caused by sEcVere portal hypertension with ectopic varices: A case report[J]. J Interv Med, 2020 3(3):157-160.
[42]	Wu X, Xuan W, Song L. Transjugular intrahepatic portosystemic stent shunt placement and embolization for hemorrhage associated with rupture of anorectal varices[J]. J Int Med Res, 2018, 46(4):1666-1671. doi: 10.1177/0300060517730720 pmid: 29338471
[43]	Roy S, Giles T, Majid A. Portal vein stenting in the management of duodenal varices due to malignant obstruction: A case report and literature rEcView[J]. Int J Surg Case Rep, 2022, 95:107246.
[44]	Fukuda K, Sasaki T, Hirasawa T, et al. A case of percutaneous transhepatic portal vein stent placement and endoscopic injection sclerotherapy for duodenal variceal rupture occurring during chemotherapy for unresectable perihilar cholangiocarcinoma[J]. Clin J Gastroenterol, 2020, 13(6):1150-1156.
[45]	Abdalla AO, Abdallah MA, Calvo LA. Successful treatment of a case of ectopic jejunal varices with portal venous stenting[J]. Am J Case Rep, 2019, 20:948-952.
[46]	Nagata J, Hirose S, Shiraishi K, et al. Vaginal bleeding in a patient with type C liver cirrhosis without a past history of laparotomy: Successful treatment with partial splenic artery embolization[J]. Clin J Gastroenterol, 2012, 5(4):275-281. doi: 10.1007/s12328-012-0316-3 pmid: 26182393
[47]	Wada T, Yano Y, Yamamoto A, et al. Jejunal variceal rupture in a patient with myelofibrosis: A case report[J]. Clin J Gastroenterol, 2021, 14(2):542-545. doi: 10.1007/s12328-021-01373-y pmid: 33675010
[48]	Haddad A, Beji H, Chaker Y, et al. Surgical treatment for bleeding ileal varices: A case report[J]. Int J Surg Case Rep, 2021, 88:106573.

门静脉高压异位静脉曲张出血的临床诊治进展

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 48

相关文章 15

编辑推荐

Metrics

本文评价

[1]	于菁怡, 司元国, 兰翠霞, 邢家璇. 新冠肺炎患者院外使用利伐沙班抗凝安全性和有效性的meta分析[J]. 临床荟萃, 2024, 39(6): 485-493.
[2]	李亚楠, 张红雨. 急性STEMI患者直接PCI时经球囊尾部于冠状动脉内注射小剂量尿激酶原的疗效[J]. 临床荟萃, 2024, 39(6): 518-523.
[3]	赵蕊, 邹俊. 马红球菌病研究进展[J]. 临床荟萃, 2024, 39(6): 559-562.
[4]	陈诗雨, 罗专波. 肿瘤相关静脉血栓栓塞症研究进展[J]. 临床荟萃, 2024, 39(4): 363-369.
[5]	孟炜丽. 北京市西城区不同结核病防治体系收治肺结核患者治疗管理情况分析[J]. 临床荟萃, 2024, 39(3): 244-248.
[6]	任雷, 刘晔, 鲍书友, 李葵芳. 母细胞性浆细胞样树突细胞肿瘤2例并文献复习[J]. 临床荟萃, 2024, 39(3): 253-258.
[7]	孙庆, 王海龙, 米庆, 乐暾, 牟华明. 外泌体在心力衰竭发生发展中的作用及临床价值[J]. 临床荟萃, 2024, 39(3): 259-263.
[8]	王奕涵, 秦旭雁, 韩宣泽, 王樱洁, 高菲菲, 陈春红, 张岭楠, 张芳. 利伐沙班用于HASBLED评分≥3分的高龄非瓣膜性心房颤动患者的有效性和安全性[J]. 临床荟萃, 2024, 39(2): 121-124.
[9]	金鑫, 吴金玲, 尹丽丽. 持续性植物状态促醒机制及治疗研究进展[J]. 临床荟萃, 2024, 39(2): 172-176.
[10]	王琦, 陈宏. 维生素D在支气管哮喘和慢性阻塞性肺疾病治疗中的应用进展[J]. 临床荟萃, 2024, 39(1): 88-91.
[11]	崔兰丹, 杨春燕. 脓毒症患者甲状腺激素的变化特点及研究进展[J]. 临床荟萃, 2024, 39(1): 70-74.
[12]	邹子良, 余海, 王迪, 褚泰运, 李驹, 钱宝堂. 冠状动脉慢性完全闭塞病变介入治疗研究现状[J]. 临床荟萃, 2024, 39(1): 80-83.
[13]	游琪琪, 霍丽娟. 原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征的诊治进展[J]. 临床荟萃, 2024, 39(1): 84-87.
[14]	王鑫, 张展, 刘铎, 谢萍. 铁缺乏与肺动脉高压相关性的研究进展[J]. 临床荟萃, 2023, 38(9): 838-844.
[15]	陈聪水, 李园, 陈淑芳. 重视儿童胆源性胰腺炎的中西医诊治(附1例分析)[J]. 临床荟萃, 2023, 38(8): 726-730.