内容紹介
Summary
It is known that gastrointestinal bleeding occurs due to portal stenosis as a complication in the hepato-biliary-pancreatic region at later postoperative stages. Our department has treated 5 portal stent cases since 2015. The pressure difference between the hepatic side and intestinal side at the portal stenosis site decreased from 9-14(median: 10)cmH2O to 0-6(median: 2)cmH2O in all cases before and after placement of the stent, resulting in hemostasis(observation period 4-18 months, median: 12 months). In surgery of the hepato-biliary-pancreatic regions, veins flowing into the portal vein are also incised by dissection of the hepatoduodenal ligament. Accordingly, it has been inferred that when the portal vein becomes stenotic, the collateral routes flow into the portal vein at the hepatic portal site in a hepatopetal manner through the cholangiojejunal anastomosis site from the mesenteric veins of the elevated jejunum, and the submucosal weak collateral routes collapse, causing gastrointestinal bleeding. Rebleeding is highly likely in cases with only endoscopic treatment and embolization of collateral routes. On the other hand, it is thought that portal stenting is a radical treatment and is thus the first option for management.
要旨
肝胆膵領域の術後晩期合併症にて門脈狭窄を来し,消化管出血がみられることが知られている。当教室では,2015年より門脈ステントを5例に留置した。門脈狭窄部の肝側と腸側の圧較差は,ステント留置前後で9～14(中央値10)cmH2Oから,0～6(中央値2)cmH2Oと全症例で低下し,止血が得られた(観察期間4～18か月,中央値12か月)。肝胆膵外科領域の手術では,肝十二指腸間膜の郭清により門脈に流入する静脈も切離される。そのため門脈が狭窄すると,側副路は挙上空腸の腸間膜静脈から胆管空腸吻合部を介して肝門部門脈に求肝性に流入し,粘膜下の脆弱な側副路が破綻し消化管出血を来すと考えられている。内視鏡治療や側副路の塞栓のみでは再出血する可能性が高い。一方,門脈ステントは根本的治療であり,第一選択の治療法と考えられる。
目次
It is known that gastrointestinal bleeding occurs due to portal stenosis as a complication in the hepato-biliary-pancreatic region at later postoperative stages. Our department has treated 5 portal stent cases since 2015. The pressure difference between the hepatic side and intestinal side at the portal stenosis site decreased from 9-14(median: 10)cmH2O to 0-6(median: 2)cmH2O in all cases before and after placement of the stent, resulting in hemostasis(observation period 4-18 months, median: 12 months). In surgery of the hepato-biliary-pancreatic regions, veins flowing into the portal vein are also incised by dissection of the hepatoduodenal ligament. Accordingly, it has been inferred that when the portal vein becomes stenotic, the collateral routes flow into the portal vein at the hepatic portal site in a hepatopetal manner through the cholangiojejunal anastomosis site from the mesenteric veins of the elevated jejunum, and the submucosal weak collateral routes collapse, causing gastrointestinal bleeding. Rebleeding is highly likely in cases with only endoscopic treatment and embolization of collateral routes. On the other hand, it is thought that portal stenting is a radical treatment and is thus the first option for management.
要旨
肝胆膵領域の術後晩期合併症にて門脈狭窄を来し,消化管出血がみられることが知られている。当教室では,2015年より門脈ステントを5例に留置した。門脈狭窄部の肝側と腸側の圧較差は,ステント留置前後で9～14(中央値10)cmH2Oから,0～6(中央値2)cmH2Oと全症例で低下し,止血が得られた(観察期間4～18か月,中央値12か月)。肝胆膵外科領域の手術では,肝十二指腸間膜の郭清により門脈に流入する静脈も切離される。そのため門脈が狭窄すると,側副路は挙上空腸の腸間膜静脈から胆管空腸吻合部を介して肝門部門脈に求肝性に流入し,粘膜下の脆弱な側副路が破綻し消化管出血を来すと考えられている。内視鏡治療や側副路の塞栓のみでは再出血する可能性が高い。一方,門脈ステントは根本的治療であり,第一選択の治療法と考えられる。