門脈血行動態から見た下行性側副血行路の形成過程とその経年的変化
血管造影にて下行性側副血行路の形成過程とその血行動態の変化を観察し得た10症例について解析した．1）3例で径8～14mm大の脾（胃）腎短絡路が4年8か月以内に形成され，うち2例で上腸間膜静脈血流の盗流現象を認め，全例で肝合成能の低下を認めた．2）短絡路を有するも上腸間膜静脈血流の盗流現象を認めなかった4例のうち，3例で2年5か月以内に上腸間膜静脈血流の盗流現象と短絡路の拡張，門脈本幹径の狭小化を認め，うち2例で肝合成能の低下を認めた．3）短絡路を有し，かつ上腸間膜静脈血流の盗流現象を認めた3症例では，その後さらに門脈本幹径の狭小化を認め，経年的に肝萎縮，肝不全を招いた．すなわち，1）下行性側副...
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| Published in | Japanese Journal of Portal Hypertension Vol. 18; no. 2; pp. 119 - 126 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本門脈圧亢進症学会
2012
The Japan Society for Portal Hypertension |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1344-8447 2186-6376 |
| DOI | 10.11423/jsph.18.119 |
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| Abstract | 血管造影にて下行性側副血行路の形成過程とその血行動態の変化を観察し得た10症例について解析した．1）3例で径8～14mm大の脾（胃）腎短絡路が4年8か月以内に形成され，うち2例で上腸間膜静脈血流の盗流現象を認め，全例で肝合成能の低下を認めた．2）短絡路を有するも上腸間膜静脈血流の盗流現象を認めなかった4例のうち，3例で2年5か月以内に上腸間膜静脈血流の盗流現象と短絡路の拡張，門脈本幹径の狭小化を認め，うち2例で肝合成能の低下を認めた．3）短絡路を有し，かつ上腸間膜静脈血流の盗流現象を認めた3症例では，その後さらに門脈本幹径の狭小化を認め，経年的に肝萎縮，肝不全を招いた．すなわち，1）下行性側副血行路が短期間に形成・拡張する症例が存在すること，2）短絡路の拡張に伴い上腸間膜静脈血流の盗流現象と門脈本幹径の狭小化，肝合成能の低下が生じ得ること，3）上腸間膜静脈血流の盗流現象を伴う短絡路の存在は，その後経年的に肝萎縮と肝不全を引き起こし得ることが明らかとなった． |
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| AbstractList | 血管造影にて下行性側副血行路の形成過程とその血行動態の変化を観察し得た10症例について解析した．1）3例で径8～14mm大の脾（胃）腎短絡路が4年8か月以内に形成され，うち2例で上腸間膜静脈血流の盗流現象を認め，全例で肝合成能の低下を認めた．2）短絡路を有するも上腸間膜静脈血流の盗流現象を認めなかった4例のうち，3例で2年5か月以内に上腸間膜静脈血流の盗流現象と短絡路の拡張，門脈本幹径の狭小化を認め，うち2例で肝合成能の低下を認めた．3）短絡路を有し，かつ上腸間膜静脈血流の盗流現象を認めた3症例では，その後さらに門脈本幹径の狭小化を認め，経年的に肝萎縮，肝不全を招いた．すなわち，1）下行性側副血行路が短期間に形成・拡張する症例が存在すること，2）短絡路の拡張に伴い上腸間膜静脈血流の盗流現象と門脈本幹径の狭小化，肝合成能の低下が生じ得ること，3）上腸間膜静脈血流の盗流現象を伴う短絡路の存在は，その後経年的に肝萎縮と肝不全を引き起こし得ることが明らかとなった． |
| Author | 木村, 公則 佐伯, 俊一 林, 星舟 今村, 潤 |
| Author_FL | Hayashi S Imamura J Saeki S Kimura K |
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| DocumentTitleAlternate | Clinical outcomes and portal hemodynamic changes in patients with spontaneous caudad portal systemic shunt |
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| References | 18) Vons C, Hadengue A, Smadja C, et al: Long-term hemodynamic effects of portocaval shunt and Sugiura procedure in patients with cirrhosis. HPB Surg 1996; 9: 209-213 15) Hsieh JS, Wang JY, Huang CJ, et al: Effect of spontaneous portosystemic shunts on hemorrhage from esophagogastric varices. World J Surg 2004; 28: 23-28 20) Bernadich C, Fernandez M, Bandi JC, et al: Mechanical pumping of portal blood to the liver: hemodynamic effects of a new experimental treatment for portal hypertension. J Hepatol 1996; 25: 98-105 11) Watanabe A: Portal-systemic encephalopathy in non-cirrhotic patients: classification of clinical types, diagnosis and treatment. J Gastroenterol Hepatol 2000; 15: 969-979 3) Rousselot LM, Moreno AH, Panke WF: Studies on portal hypertension. IV. The clinical and physiopathologic significance of self-established (nonsurgical) portal systemic venous shunts. Ann Surg 1959; 150: 384-412 5) Lam KC, Juttner HU, Reynolds TB: Spontaneous portosystemic shunt: relationship to spontaneous encephalopathy and gastrointestinal hemorrhage. Dig Dis Sci 1981; 26: 346-352 6) Ohnishi K, Sato S, Saito M, et al: Clinical and portal hemodynamic features in cirrhotic patients having a large spontaneous splenorenal and/or gastrorenal shunt. Am J Gastroenterol 1986; 81: 450-455 13) Yamada M, Ishida H, Komatsuda T, et al: Portal systemic shunt through the renal vein. Abdom Imaging 2006; 31: 701-705 21) 小山秀彦，斎藤正明，崔 世浩：巨大胃腎短絡路を有する肝性脳症を経皮経肝的短絡路塞栓術により治癒せしめた1例．肝臓 1990; 31: 694-698 14) Okuda K, Iio M: Radiological aspects of the liver and bilialy tract. X-ray and radioisotope diagnosis. Year Book 1976 19) Cardoso J, Gautreau C, Jeyaraj PR, et al: Augmentation of portal blood flow improves function of human cirrhotic liver. Hepatology 1994; 19: 375-380 17) Voorhees AB, Jr., Chaitman E, Schneider S, et al: Portal-systemic encephalopathy in the noncirrhotic patient. Effect of portal-systemic shunting. Arch Surg 1973; 107: 659-663 1) Learmonth J: On certain aspects of portal hypertension. Edinb Med J 1951; 58: 1-16 7) Tarantino G, Citro V, Conca P, et al: What are the implications of the spontaneous spleno-renal shunts in liver cirrhosis? BMC Gastroenterol 2009; 9: 89 27) Hayashi S, Saeki S, Ushimi T: Gastric fundic varices: hemodynamics and non-surgical treatment. Digestive Endoscopy 2005; 17: 198-202 4) Hamilton LC, Sullivan BH: Natural portosystemic venous shunts in portal hypertension. Med Ann Dist Columbia 1961; 30: 654-659 12) Chu Q, Li Z, Zhang SM, et al: Relationship between encephalopathy and portal vein-vena cava shunt: value of computed tomography during arterial portography. World J Gastroenterol 2004; 10: 1939-1942 25) 金川博史，美馬聰昭，香山明一，他：バルーン下逆行性経静脈的塞栓術（B-RTO）による胃静脈瘤治療．肝臓 1991; 32: 442 23) 近藤朝明，林 星舟，佐伯俊一，他：シャント閉鎖術を施行した門脈─大循環短絡路症例の検討．日本消化器病学会誌 1990; 87: 646 22) 大坪毅人，健 高，武藤晴臣，他：門脈大循環シャントを伴った肝硬変合併肝細胞癌の2治験例．肝臓 1990; 31: 342-345 9) Ohnishi K, Nakayama T, Koen H, et al: Interrelationship between type of spontaneous portal systemic shunt and portal vein pressure in patients with liver disease. Am J Gastroenterol 1985; 80: 561-564 10) Riehl J, Bongartz D, Nguyen H, et al: Spontaneous portasystemic shunt in liver cirrhosis: imaging with color-coded duplex ultrasonography. Ultraschall Med 1997; 18: 272-276 8) Nunez D, Russell E, Yrizarry J, et al: Portosystemic communications studied by transhepatic portography. Radiology 1978; 127: 75-79 26) 林 星舟，佐伯俊一，細井 仁，他：胃穹窿部静脈瘤併存胃腎短絡路閉塞後の肝機能及び門脈血行動態の変化についての検討．日本消化器病学会雑誌 1998; 95: 755-763 16) Bismuth H, Franco D, Hepp J: Portal-systemic shunt in hepatic cirrhosis: does the type of shunt decisively influence the clinical result? Ann Surg 1974; 179: 209-218 24) 鶴田耕二，岡本篤武：門脈大循環シャント閉鎖術の適応と肝に及ぼす影響．日門亢会誌 1999; 5: 83-85 2) Raskin NH, Price JB, Fishman RA: Portal-systemic encephalopathy due to congenital intrahepatic shunts. N Engl J Med 1964; 270: 225-229 |
| References_xml | – reference: 1) Learmonth J: On certain aspects of portal hypertension. Edinb Med J 1951; 58: 1-16 – reference: 9) Ohnishi K, Nakayama T, Koen H, et al: Interrelationship between type of spontaneous portal systemic shunt and portal vein pressure in patients with liver disease. Am J Gastroenterol 1985; 80: 561-564 – reference: 24) 鶴田耕二，岡本篤武：門脈大循環シャント閉鎖術の適応と肝に及ぼす影響．日門亢会誌 1999; 5: 83-85 – reference: 3) Rousselot LM, Moreno AH, Panke WF: Studies on portal hypertension. IV. The clinical and physiopathologic significance of self-established (nonsurgical) portal systemic venous shunts. Ann Surg 1959; 150: 384-412 – reference: 25) 金川博史，美馬聰昭，香山明一，他：バルーン下逆行性経静脈的塞栓術（B-RTO）による胃静脈瘤治療．肝臓 1991; 32: 442 – reference: 17) Voorhees AB, Jr., Chaitman E, Schneider S, et al: Portal-systemic encephalopathy in the noncirrhotic patient. Effect of portal-systemic shunting. Arch Surg 1973; 107: 659-663 – reference: 15) Hsieh JS, Wang JY, Huang CJ, et al: Effect of spontaneous portosystemic shunts on hemorrhage from esophagogastric varices. World J Surg 2004; 28: 23-28 – reference: 19) Cardoso J, Gautreau C, Jeyaraj PR, et al: Augmentation of portal blood flow improves function of human cirrhotic liver. Hepatology 1994; 19: 375-380 – reference: 27) Hayashi S, Saeki S, Ushimi T: Gastric fundic varices: hemodynamics and non-surgical treatment. Digestive Endoscopy 2005; 17: 198-202 – reference: 4) Hamilton LC, Sullivan BH: Natural portosystemic venous shunts in portal hypertension. Med Ann Dist Columbia 1961; 30: 654-659 – reference: 20) Bernadich C, Fernandez M, Bandi JC, et al: Mechanical pumping of portal blood to the liver: hemodynamic effects of a new experimental treatment for portal hypertension. J Hepatol 1996; 25: 98-105 – reference: 14) Okuda K, Iio M: Radiological aspects of the liver and bilialy tract. X-ray and radioisotope diagnosis. Year Book 1976 – reference: 8) Nunez D, Russell E, Yrizarry J, et al: Portosystemic communications studied by transhepatic portography. Radiology 1978; 127: 75-79 – reference: 16) Bismuth H, Franco D, Hepp J: Portal-systemic shunt in hepatic cirrhosis: does the type of shunt decisively influence the clinical result? Ann Surg 1974; 179: 209-218 – reference: 13) Yamada M, Ishida H, Komatsuda T, et al: Portal systemic shunt through the renal vein. Abdom Imaging 2006; 31: 701-705 – reference: 26) 林 星舟，佐伯俊一，細井 仁，他：胃穹窿部静脈瘤併存胃腎短絡路閉塞後の肝機能及び門脈血行動態の変化についての検討．日本消化器病学会雑誌 1998; 95: 755-763 – reference: 18) Vons C, Hadengue A, Smadja C, et al: Long-term hemodynamic effects of portocaval shunt and Sugiura procedure in patients with cirrhosis. HPB Surg 1996; 9: 209-213 – reference: 6) Ohnishi K, Sato S, Saito M, et al: Clinical and portal hemodynamic features in cirrhotic patients having a large spontaneous splenorenal and/or gastrorenal shunt. Am J Gastroenterol 1986; 81: 450-455 – reference: 5) Lam KC, Juttner HU, Reynolds TB: Spontaneous portosystemic shunt: relationship to spontaneous encephalopathy and gastrointestinal hemorrhage. Dig Dis Sci 1981; 26: 346-352 – reference: 10) Riehl J, Bongartz D, Nguyen H, et al: Spontaneous portasystemic shunt in liver cirrhosis: imaging with color-coded duplex ultrasonography. Ultraschall Med 1997; 18: 272-276 – reference: 11) Watanabe A: Portal-systemic encephalopathy in non-cirrhotic patients: classification of clinical types, diagnosis and treatment. J Gastroenterol Hepatol 2000; 15: 969-979 – reference: 21) 小山秀彦，斎藤正明，崔 世浩：巨大胃腎短絡路を有する肝性脳症を経皮経肝的短絡路塞栓術により治癒せしめた1例．肝臓 1990; 31: 694-698 – reference: 12) Chu Q, Li Z, Zhang SM, et al: Relationship between encephalopathy and portal vein-vena cava shunt: value of computed tomography during arterial portography. World J Gastroenterol 2004; 10: 1939-1942 – reference: 23) 近藤朝明，林 星舟，佐伯俊一，他：シャント閉鎖術を施行した門脈─大循環短絡路症例の検討．日本消化器病学会誌 1990; 87: 646 – reference: 7) Tarantino G, Citro V, Conca P, et al: What are the implications of the spontaneous spleno-renal shunts in liver cirrhosis? BMC Gastroenterol 2009; 9: 89 – reference: 2) Raskin NH, Price JB, Fishman RA: Portal-systemic encephalopathy due to congenital intrahepatic shunts. N Engl J Med 1964; 270: 225-229 – reference: 22) 大坪毅人，健 高，武藤晴臣，他：門脈大循環シャントを伴った肝硬変合併肝細胞癌の2治験例．肝臓 1990; 31: 342-345 |
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| SubjectTerms | hepatic atrophy hepatic failure portal hemodynamics spontaneous portal systemic shunt steal phenomenon |
| Title | 門脈血行動態から見た下行性側副血行路の形成過程とその経年的変化 |
| URI | https://www.jstage.jst.go.jp/article/jsph/18/2/18_119/_article/-char/ja https://cir.nii.ac.jp/crid/1390282679458992000 |
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