胃と腸41巻4号

2006年04月発行

特集 消化管内視鏡治療2006 各論 2. 良性腫瘍に対する内視鏡治療

3)大腸　(3)血管性病変

著者： 松本主之¹ 中村昌太郎¹ 城由起彦¹ 蔵原晃一² 小林広幸² 渕上忠彦² 飯田三雄¹

所属機関： ¹九州大学大学院病態機能内科学 ²松山赤十字病院胃腸センター

ページ範囲：P.610 - P.616

要旨　消化管に好発する血管性病変として，血管異形成（angiodysplasia），動・静脈奇形（arteriovenous malformation），Dieulafoy潰瘍，血管腫が挙げられる．前2者はいずれも大腸に好発し，消化管出血を来す場合は治療の適応となる．大腸の血管性病変に対する内視鏡的治療法として凝固法，局注法，機械的圧迫法，切除法がある．粘膜内毛細血管の拡張にとどまる血管異形成に対しては上記のいずれも有効であるが，動静脈奇形では静脈瘤に準じた硬化療法が必要となる．したがって，両者を鑑別することは重要である．Dieulafoy潰瘍に対しては凝固法，局注法が用いられてきたが，最近では機械的圧迫法として止血クリップが簡便かつ有効とされる．一方，血管腫の中でも単発性海綿状血管腫は明らかな隆起性病変を呈し，内視鏡的ポリペクトミーによる切除例が増加しているが，偶発症の報告は少ない．

参考文献

1) Moore JD, Thompson NW, Appleman HD, et al. Arteriovenous malformations of the gastrointestinal tract. Arch Surg 111 : 381-389, 1976

2) Camilleri M, Chadwick VS, Hodgson HJF. Vascular anomalies of the gastrointestinal tract. Hepatogastroenterology 31 : 149-153, 1984

3) Richardson JD. Vascular lesions of the intestines. Am J Surg 161 : 284-293, 1991

4) 岩下明徳，尾石樹泰，八尾隆史，他．腸管の血管性病変の病理学的鑑別診断．胃と腸 35 : 771-784, 2000

5) 古賀秀樹，飯田三雄，垂水研一．最近10年間(1990-1999)の本邦報告例の集計からみた消化管の血管性病変．胃と腸 35 : 743-752, 2000

6) Boley SJ, Sammartano R, Brandt LJ, et al. On the nature and etiology of vascular ectasia of the colon. Degenerative lesions of aging. Gastroenterology 72 : 650-660, 1976

7) Danesh BJ, Spiliadis C, Williams CB, et al. Angiodysplasia. An uncommon cause of colonic bleeding. Colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia. Int J Colorectal Dis 2 : 218-222, 1987

8) Foutch PG, Rec DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol 90 : 564-567, 1995

9) 鈴木康元，西野晴夫，渡辺豊，他．大腸angiodysplasia79例の臨床的検討．消化器内視鏡の進歩 40 : 221-224, 1992

10) 酒井義浩，須田浩晃，小林博之，他．大腸のangiectasiaとangiodysplasia．胃と腸 35 : 763-769, 2000

11) 郷田憲一，多田修治，今村治男，他．内視鏡的ポリペクトミーにて治療し得た有茎性大腸angiodysplasiaの1例．Gastroenterol Endosc 40 : 2143-2148, 1998

12) Sawada T, Kawamura O, Kodama T, et al. Pedunculated angiodysplasia of the colon successfully treated with endoscopy. A new type of angiodysplasia. Endoscopy 57 : 602-605, 2003

13) Chung YW, Jeon YC, Paik CH, et al. Pedunculated angiodysplasia of the colon treated with endoscopic resection. A case report. Dig Dis Sci 50 : 1550-1552, 2005

14) Rogers BHG, Adler F. Hemangiomas of the cecum. Gastroenterology 71 : 1079-1082, 1976

15) Heyde EC. Gastrointestinal bleeding in aortic stenosis. N Engl J Med 259 : 196, 1958

16) Vincentelli A, Susen S, Le Tourneau T, et al. Acuired von Willebrand syndrome in aortic stenosis. N Engl J Med 349 : 343-349, 2003

17) Rutgeerts P, van Gompel F, Geboes K, et al. Long-term results of treatment of vascular malformations of the gastrointestinal tract by Neodymium-Yag laser photocoagulation. Gut 26 : 586-593, 1985

18) Cello JP, Grendell JH. Endoscopic treatment for gastrointestinal vascular ectasias. Ann Intern Med 104 : 352-354, 1986

19) D'Harveng LB, Vanheuverzwyn R, Debongnie JC, et al. Colonic angiodysplasia. Follow-up of patients after endoscopic treatment for bleeding lesions. Dis Colon Rectum 32 : 296-298, 1989

20) Rogers BH. Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular, and pulmonary disease. Gastrointest Endosc 26 : 134-138, 1980

21) 田沢潤一，山岡一昭，小泉和彦，他．内視鏡的治療が奏効した大腸angiodysplasiaの1例．日消誌 89 : 2794-2797, 1992

22) Gupta N, Longo WE, Vernava AM. Angiodysplasia of the lower gastrointestinal tract. An entity readily diagnosed by colonoscopy and primarily managed nonoperatively. Dis Colon Rectum 38 : 979-982, 1995

23) Olmos JA, Marcolongo M, Pogorelsky V, et al. Argon plasma coagulation of recurrent bleeding from GI angiodysplasias. Gastrointest Endosc 60 : 881-886, 2004

24) Cohen SC, Liangpunsakul S, Rex DK. Watermelon colon treated by argon plasma coagulation. Gastrointest Endosc 61 : 631-633, 2005

25) Jaspersen D, Koörner T, Schorr W, et al. Diagnosis and treatment control of bleeding colorectal angiodysplasia by endoscopic Doppler sonography. A preliminary study. Gastrointest Endosc 40 : 40-44, 1994

26) Bemvenuti GA, Juulich MM. Ethanolamine injection for sclerotherapy of angiodysplasia of the colon. Endoscopy 30 : 564-569, 1998

27) 古賀秀樹，飯田三雄，西本好徳，他．内視鏡的粘膜切除術で治療しえた盲腸angiodysplasiaの1例．胃と腸 35 : 797-802, 2000

28) Margulis AR, Heinbecker P, Bernard HR, et al. Operative mesenteric arteriography in the search for the site of bleeding in unexplained gastrointestinal hemorrhage. Surgery 48 : 534-539, 1960

29) Tark M, Gostout C, Balm R. Clinical features and endoscopic management of Dieulafoy's disease. Gastrointest Endosc 38 : 545-550, 1992

30) Norton ID, Petersen BT, Sorbi D, et al. Management and long term prognosis of Dieulafoy's lesion. Gastrointest Endosc 50 : 762-767, 1999

31) Meister TE, Varliek GW, Marsano LS, et al. Endoscopic management of rectal Dieulafoy-like lesions. A case series and review of literature. Gastrointest Endosc 48 : 302-305, 1998

32) Chung IK, Kim EL, Lee MS, et al. Bleeding Dieulafoy's lesions and the choice of endoscopic method. Comparing the hemostatic efficacy of mechanical and injection methods. Gastrointest Endosc 52 : 721-724, 2000

33) Gimeno-Garía AZ, Parra-Blanco A, Nicolas-Pérez D, et al. Management of colonic Dieulafoy lesions with endoscopic mechanical techniques. Report of two cases. Surg Endosc 47 : 1539-1543, 2004

34) Nozoe T, Kitamura M, Matsumata T, et al. Dieulafoy-like lesions of colon and rectum in patients with chronic renal failure on long-term hemodialysis. Hepatogastroenterology 46 : 3121-3123, 1999

35) Katsinelos P, Pilpilidis I, Paroutoglou G, et al. Dieulafoy-like lesion of the colon presenting with massive lower gastrointestinal bleeding. Surg Endosc 18 : 346, 2004

36) 鈴木貴久，鈴木孝，篠田昌孝，他．留置スネアを用いた内視鏡的ポリペクトミーにより診断・治療した大腸海綿状血管腫の1例．Gastroenterol Endosc 46 : 2409-2415, 2004