部分的脾動脈塞栓術により貧血が改善した門脈圧亢進症性十二指腸症の1例
症例は66歳，女性．非アルコール性脂肪肝炎(non alcoholic steatohepatitis；NASH)による肝硬変があり門脈圧亢進症をきたしていた．2005年10月より食道静脈瘤，前庭部びまん性毛細血管拡張(gastric antral vascular ectasia：GAVE)，門脈圧亢進症性十二指腸症(portal hypertensive duodenopathy：PHD)があり著明な貧血があった．内視鏡的静脈瘤硬化療法(endoscopic injection sclerotherapy：EIS)とGAVEに対するアルゴンプラズマ凝固止血法(argon plasma co...
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| Published in | Japanese Journal of Portal Hypertension Vol. 19; no. 2; pp. 129 - 133 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本門脈圧亢進症学会
2013
The Japan Society for Portal Hypertension |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1344-8447 2186-6376 |
| DOI | 10.11423/jsph.19.129 |
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| Abstract | 症例は66歳，女性．非アルコール性脂肪肝炎(non alcoholic steatohepatitis；NASH)による肝硬変があり門脈圧亢進症をきたしていた．2005年10月より食道静脈瘤，前庭部びまん性毛細血管拡張(gastric antral vascular ectasia：GAVE)，門脈圧亢進症性十二指腸症(portal hypertensive duodenopathy：PHD)があり著明な貧血があった．内視鏡的静脈瘤硬化療法(endoscopic injection sclerotherapy：EIS)とGAVEに対するアルゴンプラズマ凝固止血法(argon plasma coagulation：APC)を繰り返されていたが，PHDは改善しないため貧血は一時改善するもすぐに悪化していた．2009年1月に貧血が再度増悪した．PHDに対して門脈圧亢進症の改善を目的に部分的脾動脈塞栓術(partial splenic embolization：PSE)を施行．GAVEにもAPCを加え貧血は著明に改善した．PHDへのPSEの報告はまれで貴重な症例と考えられた． |
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| AbstractList | 症例は66歳，女性．非アルコール性脂肪肝炎(non alcoholic steatohepatitis；NASH)による肝硬変があり門脈圧亢進症をきたしていた．2005年10月より食道静脈瘤，前庭部びまん性毛細血管拡張(gastric antral vascular ectasia：GAVE)，門脈圧亢進症性十二指腸症(portal hypertensive duodenopathy：PHD)があり著明な貧血があった．内視鏡的静脈瘤硬化療法(endoscopic injection sclerotherapy：EIS)とGAVEに対するアルゴンプラズマ凝固止血法(argon plasma coagulation：APC)を繰り返されていたが，PHDは改善しないため貧血は一時改善するもすぐに悪化していた．2009年1月に貧血が再度増悪した．PHDに対して門脈圧亢進症の改善を目的に部分的脾動脈塞栓術(partial splenic embolization：PSE)を施行．GAVEにもAPCを加え貧血は著明に改善した．PHDへのPSEの報告はまれで貴重な症例と考えられた． |
| Author | 池田, 宜央 日浅, 陽一 恩地, 森一 小泉, 洋平 越智, 裕紀 布井, 弘明 川崎, 敬太郎 阿部, 雅則 田中, 宏明 廣岡, 昌史 徳本, 良雄 |
| Author_FL | Abe M Tanaka H Koizumi Y Tokumoto Y Ikeda N Onji M Nunoi H Kawasaki K Koshichi H Hirooka M Hiasa Y |
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| References | 21) Kamath PS, Lacerda M, Ahlquist DA, et al: Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology 2000; 118: 905-911 19) Hidaka H, Nakazawa T, Shibuya A, et al: Effects of 1-year administration of olmesartan on portal pressure and TGF-beta1 in selected patients with cirrhosis: a randomized controlled trial. J Gastroenterology 2011; 46: 1316-1323 1) 広岡昌史，上原貴秀，恩地森一：肝動注化学療法における脾摘術とPSEの功罪．肝胆膵 2008; 56: 377-381 5) Primignani M, Carpinelli L, Preatoni P, et al: Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic club for the study and treatment of esophageal varices (NIEC). Gastroenterology 2000; 119: 181-187 2) Yoshida H, Mamada Y, Taniai N, et al: Partial splenic embolization. Hepatology Research 2008; 38: 225-233 13) 吉田 寛：門脈圧亢進症における脾静脈血行動態の検討．日消誌 1991; 88: 2763-2770 16) Chikamori F, Kuniyoshi N, Kawashima T, et al: Combination treatment of partial splenic embolization, endoscopic embolization and transjugular retrograde obliteration for complicated gastroesophageal varices. Hepatogastroenterology 2004; 51: 1506-1509. 6) Kozarek RA, Botoman VA, Bredfeldt JE, et al: Portal colopathy: prospective study of colonoscopy in patients with portal hypertension. Gastroenterology 1991; 101: 1192-1197 3) 吉松英輝，高塚健太郎，岩淵省吾：部分的脾動脈塞栓術における門脈血行動態の変化と血清アルブミン値に関する検討．肝臓 2007; 48: 153-160 4) McCormack TT, Simms J, Eyre-Brook I, et al: Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy? Gut 1985; 26: 1226-1232 7) Naveau S, Bedossa P, Poynard T, et al: Portal hypertensive colopathy. A new entity. Dig Dis Sci 1991; 36: 1774-1781 17) Garcia-Tsao G, Bosch J, Groszmann RJ: Portal hypertension and variceal bleeding--unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single-topic conference. Hepatology 2008; 47: 1764-1772 8) 松井秀隆，檜垣直幸，池田宜央，他：門脈圧亢進症性小腸症(portal hypertensive enteropathy; PHE)．胃と腸 2008; 43: 723-726 9) Higaki N, Matsui H, Imaoka H, et al: Endoscopic characteristics features of portal hypertensive enteropathy. J Gastroenterology 2008; 43: 327-331 12) Helmy A, Jalan R, Newby DE, et al: Role of angiotensin II in regulation of basal and sympathetically stimulated vascular tone in early and advanced cirrhosis. Gastroenterology 2000; 118: 565-572 18) Groszmann RJ, Garcia-Tsao G, Bosch J, et al: Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: 2254-2261. 11) 水野秀樹，加賀谷尚史，大石尚毅，他：肝硬変に伴う門脈圧亢進症における小腸病変の検討．Gastroenterological Endoscopy 2011; 53: 1600-1607 15) 石原克俊，石田竜二，斎藤友雄，他：部分的脾動脈塞栓術によって胃静脈瘤，門脈圧亢進症性胃症の所見が軽快した1例．臨放 2005; 50: 309-312 14) Shimizu T, Onda M, Tajiri T, et al: Bleeding portal-hypertensive gastropathy managed successfully by partial splenic embolization. Hepatogastroenterology 2002; 49: 947-949. 10) Shudo R, Yazaki Y, Sakurai S, et al: Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy. Am J Gastroenterology 2002; 97: 867-873 20) Hirooka M, Ishida K, Kisaka Y, et al: Ef ficacy of splenectomy for hypersplenic patients with advanced hepatocellular carcinoma. Hepatology Research 2008; 38: 1172-1177 |
| References_xml | – reference: 7) Naveau S, Bedossa P, Poynard T, et al: Portal hypertensive colopathy. A new entity. Dig Dis Sci 1991; 36: 1774-1781 – reference: 20) Hirooka M, Ishida K, Kisaka Y, et al: Ef ficacy of splenectomy for hypersplenic patients with advanced hepatocellular carcinoma. Hepatology Research 2008; 38: 1172-1177 – reference: 2) Yoshida H, Mamada Y, Taniai N, et al: Partial splenic embolization. Hepatology Research 2008; 38: 225-233 – reference: 8) 松井秀隆，檜垣直幸，池田宜央，他：門脈圧亢進症性小腸症(portal hypertensive enteropathy; PHE)．胃と腸 2008; 43: 723-726 – reference: 11) 水野秀樹，加賀谷尚史，大石尚毅，他：肝硬変に伴う門脈圧亢進症における小腸病変の検討．Gastroenterological Endoscopy 2011; 53: 1600-1607 – reference: 17) Garcia-Tsao G, Bosch J, Groszmann RJ: Portal hypertension and variceal bleeding--unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single-topic conference. Hepatology 2008; 47: 1764-1772 – reference: 5) Primignani M, Carpinelli L, Preatoni P, et al: Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic club for the study and treatment of esophageal varices (NIEC). Gastroenterology 2000; 119: 181-187 – reference: 16) Chikamori F, Kuniyoshi N, Kawashima T, et al: Combination treatment of partial splenic embolization, endoscopic embolization and transjugular retrograde obliteration for complicated gastroesophageal varices. Hepatogastroenterology 2004; 51: 1506-1509. – reference: 14) Shimizu T, Onda M, Tajiri T, et al: Bleeding portal-hypertensive gastropathy managed successfully by partial splenic embolization. Hepatogastroenterology 2002; 49: 947-949. – reference: 12) Helmy A, Jalan R, Newby DE, et al: Role of angiotensin II in regulation of basal and sympathetically stimulated vascular tone in early and advanced cirrhosis. Gastroenterology 2000; 118: 565-572 – reference: 6) Kozarek RA, Botoman VA, Bredfeldt JE, et al: Portal colopathy: prospective study of colonoscopy in patients with portal hypertension. Gastroenterology 1991; 101: 1192-1197 – reference: 9) Higaki N, Matsui H, Imaoka H, et al: Endoscopic characteristics features of portal hypertensive enteropathy. J Gastroenterology 2008; 43: 327-331 – reference: 13) 吉田 寛：門脈圧亢進症における脾静脈血行動態の検討．日消誌 1991; 88: 2763-2770 – reference: 1) 広岡昌史，上原貴秀，恩地森一：肝動注化学療法における脾摘術とPSEの功罪．肝胆膵 2008; 56: 377-381 – reference: 3) 吉松英輝，高塚健太郎，岩淵省吾：部分的脾動脈塞栓術における門脈血行動態の変化と血清アルブミン値に関する検討．肝臓 2007; 48: 153-160 – reference: 19) Hidaka H, Nakazawa T, Shibuya A, et al: Effects of 1-year administration of olmesartan on portal pressure and TGF-beta1 in selected patients with cirrhosis: a randomized controlled trial. J Gastroenterology 2011; 46: 1316-1323 – reference: 18) Groszmann RJ, Garcia-Tsao G, Bosch J, et al: Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: 2254-2261. – reference: 21) Kamath PS, Lacerda M, Ahlquist DA, et al: Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology 2000; 118: 905-911 – reference: 10) Shudo R, Yazaki Y, Sakurai S, et al: Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy. Am J Gastroenterology 2002; 97: 867-873 – reference: 15) 石原克俊，石田竜二，斎藤友雄，他：部分的脾動脈塞栓術によって胃静脈瘤，門脈圧亢進症性胃症の所見が軽快した1例．臨放 2005; 50: 309-312 – reference: 4) McCormack TT, Simms J, Eyre-Brook I, et al: Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy? Gut 1985; 26: 1226-1232 |
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| Snippet | 症例は66歳，女性．非アルコール性脂肪肝炎(non alcoholic steatohepatitis；NASH)による肝硬変があり門脈圧亢進症をきたしていた．2005年10月より食道静脈瘤，前庭部びまん性毛細血管拡張(gastric antral vascular... |
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| SubjectTerms | partial splenic embolization 前庭部びまん性毛細血管拡張症 門脈圧亢進症性十二指腸症 |
| Title | 部分的脾動脈塞栓術により貧血が改善した門脈圧亢進症性十二指腸症の1例 |
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