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症例は43歳の女性で, 2002年7月12日より腹痛および下痢があり, 7月22日当院初診となった. 腹部超音波検査およびCT検査にて腸重積と診断. しかし, 腹部単純X線上イレウス像を認めず, 臨床症状も重篤ではなく, 本人の希望もあって経過を見ていた. しかし, その後も症状改善せず初診から9日後に開腹手術を行った. 手術所見では盲腸内の粘膜下腫瘍が先進部となり回腸が上行結腸内まで重積していた. これを用手的に圧出, 解除後, 回盲部切除術にて病変を摘出した. 切除標本は5cm大の粘膜下腫瘍で, 病理学的検索にて盲腸子宮内膜症と判明した. 腸重積を合併した盲腸子宮内膜症の報告は少なく, 本邦においては本症例が2例目, 国内外を合わせても6例目となる.

要旨:リアルタイム断層ドップラー血流映像装置(real-time tow-dimensional Doppler echography: 2-D-Doppler)により興味ある所見が得られたヘパトーマ症例4例を呈示し,同装置のヘパトーマ観察に於ける有用性について検討した.(1) 2-D-Dopplerは血流のカラー表示により腫瘍内外の脈管の同定と追跡を容易にした.(2) 腫瘍内外を走る脈管内の血流方向,速度を色調ないし輝度の違いとして把えることができた.(3) 2-D-DopplerはTAE前後の腫瘍内動脈血流の変化や腫瘍内のA-Pシャントの認知にも有用であった.(4) 肝硬変症のような遅い門脈血流のカラー表示は困難な場合が多く,今後改良すべき点と考えられた.

食道静脈瘤に対する内視鏡的硬化療法 (ST) 施行後死亡例について臨床的分析を行った.ST症例は50例であったが, 1ヵ月～3年1ヵ月の追跡期間中, 26例 (52%) がすでに死亡.このうち, 入院死亡は16例, 退院死亡が10例であった.入院死亡が多い理由の一つとして, 多臓器不全の状態のChildC症例が多かったことがあげられた.Child AまたはBの吐血例 (n: 10) にはST後に手術 (主として選択的シャント手術) が施行されたが, 入院死亡となった例はなく, 累積生存も2年で89%と良好であった.一方, STのみで退院した22例中9例 (40.9%) がすでに死亡し, 2年までの累積生存率は46%であった.退院後死亡例中, 3例は出血が死因となっており, ST後の内視鏡による定期的チェックがのぞまれた.

• Sclerotherapy for esophageal varices was performed on six patients for a total of 16 injections. The sclerosant contained 5% ethanolamine oleate and technetium Tc 99m sodium pertechnetate solution at the volume ratio of 9:1. At each injection session 5 to 20 mL of this solution was injected into one varix. The distribution of the injected material was observed by a scintillation camera. Systemic dissemination of the sclerosant through the portal vein was demonstrated in five procedures, in which the injections were correctly intravenous. In three dogs 4 mL of 5% ethanolamine oleate made from oleic acids labeled with iodine 131 was injected into the gastric coronary vein. Most of the substance injected was washed out within five minutes, and systemic dissemination became evident. (Arch Surg1985;120:833-836)

A 41-year-old woman with cirrhosis of the liver was admitted to our hospital because of a severe melena. Blood pool scanning with labelled red blood cells showed a high concentration in the right upper quadrant of the abdomen. Endoscopy of the second portion of the duodenum revealed fresh blood on the first examination and varices with overlying erosion were evident in the second study. Co-existent esophageal varices were present but were apparently not associated with the bleeding. Because of the continuous hypotension even with blood replacement, ligation and sclerotherapy were performed. To evaluate the efficacy of the procedures, intraoperative two-dimensional Doppler echography was used and the transducer was applied directly to the viscera. Blood flow was visualized in the serosal and submucosal varices. After ligation and sclerosing of the veins, the blood flow velocity signals disappeared. This woman died of multiple organ failure on the ninth postoperative day.

Using a convex array transducer, the advantages and shortcomings of transesophageal real-time two-dimensional Doppler echography (TE2DD) were assessed in a study of the vessels around the esophagus and the stomach in 67 adult patients with (n = 56) or without (n = 11) liver cirrhosis. In most cases, all but the upper- and lowermost margins of the azygos vein could be visualized. The more caudally the portion located, the smaller its diameter and flow velocity became. The average number of intercostal veins visualized by TE2DD was 4 per person. The observable esophagogastric varices seemed to be limited to deeply located ones around the esophagogastric junction. In five patients who had undergone distal splenorenal shunt, splenic venous flow, or shunt flow could be seen from the stomach over a length of about 5 cm. The azygos venous flow in cirrhotic patients was significantly greater than that of patients without cirrhosis. TE2DD appears to be very useful for evaluating flow in the cephalad collateral veins and other vessels around the esophagus and the stomach.