异位曲张静脉(ectopic varices,EV)是指门静脉高压于食管胃底以外发生的曲张静脉,可单独存在或伴有其他部位的曲张静脉.EV可发生于除食管胃底以外的消化道任意部位,不同部位的异位出血包括十二指肠、空肠、肝区、结肠、直肠、肛缘、胆道系统、造瘘口、腹膜、脐周、肝镰状韧带、肝脏裸区、脾脏韧带、膀胱、横膈、卵巢和睾丸[1],膀胱、阴道、腹壁、腹膜、肝胃韧带、脾周等的发生率很低[2].EV破裂导致的出血占门静脉高压性出血的5％左右,但死亡率可达到40％[3].EV较少见,多为个案报道,目前临床对其治疗经验非常有限,故了解这些EV及出血的病例对消化道出血的诊断和治疗有积极的临床意义。

Objective To evaluate the benefits and the risk of pulmonary embolism between walking exercises and bed rest in the acute stage of deep venous thrombosis (DVT). Methods From February 2008 to March 2009,40 acute primary DVT patients were arbitrarily randomized into controlled group and experimental group,with 20 cases in each group,who were hospitalized within seven days of onset.Patients in controlled group underwent bed rest for 7-10 days,wearing elastic stockings.While patients in experimental group were early (1-2 days after admission) off bed walking about 600-1200 m every day with elastic stockings for 7-10 days.During the process patients in both group received regular anticoagulation treatment,and continued warfarin anticoagulation therapy after out of hospital for at least 6 months.The clinical characteristics of the two groups were comparable.Primary end points were the reduction of pain assessed daily with the Visual Analogue Scale (VAS),the reduction of leg circumference at thigh,and cumulative pulmonary embolism incidences of two groups in three months. Results Symptoms in all patients of the two groups were improved,but the pain level showed a statistically significant reduction starting after the third day(58 ±8) mm in the experiment group and after the fifth day (58 ± 13) mm in the controlled group.The leg circumferences of the two groups after 7 days were statistically significantly different (P ＜ 0.05),the cumulative pulmonary embolism incidences of the two groups for 3 months were not statistically significantly different. Conclusion Mobile patients with acute DVT should be encouraged to walk with medical compression stockings.The rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression.The quality of life significantly improved.The risk of pulmonary embolism does not significantly increase by this approach.