超声检查门静脉海绵样变特征表现

目的 探讨门静脉海绵样变(CTPV)及其相关并发症的超声表现特征,并分析了超声漏诊的原因.方法 2017年6月～2020年6月首都医科大学附属北京地坛医院诊治的101例CTPV患者,经CT和MRI增强扫描诊断,接受腹部超声检查.总结CTPV及其相关并发症超声图像表现特征,并分析超声漏诊的原因,提出解决策略.结果 在本组...     

成人门静脉海绵样变性1例

门静脉海绵样变性（cavemous transformation of poemvein，cTPv）为肝前性门静脉高压症，主要表现为脾功能亢进症、食管、胃底静脉曲张及反复上消化道出血，临床上极为少见，易误诊为肝硬化。我院收治1例CTPV患者，现将临床资料分析报告如下。     

亲体肝移植治疗儿童门静脉海绵样变性3例临床分析

目的 评估亲体肝移植手术治疗儿童门静脉海绵样变性的疗效.方法 3例因反复上消化道大出血、顽固性腹水和脾功能亢进患儿,经门静脉显影、螺旋CT扫描及门静脉三维影像重建技术确诊为门静脉海绵样变性,伴有严重的门静脉高压症患儿,分别于2006年7月、11月和2007年1月施行亲体肝移植术治疗.术后从临床表现、血液学指标和影像学资料等方面对手术疗效进行评价.结果 术后3例患儿中有2例消化道出血停止、腹水消失、门静脉高压症状消失,血红蛋白、红细胞压积、血小板水平和血浆白蛋白等均恢复正常,随访至今无复发;另1例术后3 d因术后门静脉血栓形成死亡. 结论 亲体肝移植可能是治疗儿童门静脉海绵样变性伴严重门静脉高压的有效方法,但门静脉重建是此类疾病进行亲体肝移植手术的难点.     

胆管结石合并门静脉海绵样变外科治疗的回顾性分析

目的分析胆管结石合并门静脉海绵样变性(CTPV)的临床特点,探讨治疗方式。方法回顾性分析2009年1月至2012年12月本院收治的胆管结石合并CTPV患者18例的临床资料,包括治疗方法、手术方法、手术时间、术中出血量、并发症、结石清除率等。结果本组病例中无死亡病例。行经内镜逆行胰胆管造影(ERCP)者8例,经肝门途径取石者3例,手术时间2.9~5.4 h(平均3.8 h),术中出血量150~2630 ml(平均430 ml),术后结石残余率为11%。结论对于合并慢性肝病病史、多次胆道手术病史尤其是合并多次胆道感染患者,须警惕是否合并CTPV,术前依据影像学资料、肝功能及患者一般情况等制定个体化治疗方案,术中利用胆道镜尽量取尽结石,必要时利用超声协助行肝叶切除以去除肝内胆管结石。     

门静脉海绵样变性的临床诊疗进展

门静脉海绵样变性(cavemous transformation of portal vein,CTPV)是指门静脉主干或其分支受阻后,机体为维持肝脏血流灌注,在肝门区代偿性形成的大量海绵样侧支血管丛.该病较罕见,临床实践中缺乏对其病因及诊疗原则的认识.对于出现门静脉高压相关症状的患者需要采取积极治疗措施.治疗的主要目...     

超声内镜诊断门静脉海绵样变性引起的胆总管扩张一例

超声内镜诊断门静脉海绵样变性引起的胆总管扩张一例     

脾外伤致门静脉海绵样变性1例

1临床资料患者,男,52岁,汉族,吉林省扶余县人,因间断性左上腹部隐痛1年,加重伴乏力3个月来我院就诊。该患者1年前因左上腹部撞击伤后开始出现上腹部疼痛,疼痛性质为隐痛,无恶心、呕吐,无腹胀,无反酸、胃内烧灼感,无厌油腻,无呕血、黑便,自行服用"消炎药"后症状略缓解,因不影响日常生活,未系统     

门静脉海绵样变性的超声表现

门静脉海绵样变性是指门静脉完全或部分阻塞后，其周围形成大量侧枝循环或栓塞后再沟通，门静脉腔内或周围有多数间隔呈海绵状。门静脉是由脾静脉及肠系膜上静脉在胰颈后方汇合而成，其主干内径约8～15cm，本病主要由肝癌伴门静脉癌栓、肝硬化、原发性血小板增多症及阻塞性黄疸等引起。     

门静脉海绵样变性一例

患者女，62岁，因中上腹疼痛伴恶心十余天，加重半天入院。患者十余天前无明显诱因下出现持续性中上腹隐痛，伴轻微恶心，无呕吐。在我院门诊予解痉等输液冶疗过程中自觉腹痛加剧，伴恶心，且疼痛向腰背部放射。4年前有“急性胰腺炎”病史。入院体检：心肺无异常，腹平软，中上腹压痛明显，无反跳痛，无肌紧张，肝脾肋下未及，肠鸣音正常，双肾区无叩痛，双下肢无浮肿。     

门静脉海绵样变性病因及治疗

目的 探讨门静脉海绵样变性的病因和治疗。方法 对28例门静脉海绵样变性住院患者的临床资料进行回顾性分析。结果 2B例患者中15例（占53．6％）病因比较明确，13例（占46．4％）未发现明确病因；28例患者中20例有出血史，其中15例行内镜下套扎、硬化剂或组织胶注射治疗，随访4～96月，食管胃底静脉曲张基本消失，1例因食管溃疡再发出血，1例出现食管狭窄。结论 门静脉海绵样变性的病因为多因素；对有消化道出血的患者内镜下治疗可以起到急诊止血和预防再出血的作用。     

Sixty-four-slice computed tomography in surgical strategy of portal vein cavernous transformation

AIM:To investigate the role of 64-slice computed tomography(CT) in portal vein cavernous transformation to determine surgical strategy.METHODS:The site of lesions and extent of collateral circulation in 12 pediatric cases of cavernous transformation of the portal vein with surgical treatment were analyzed.RESULTS:Eleven of 12 children had esophageal varices and were treated with lower esophageal and gastric devascularization and splenectomy,and the other case was only treated with splenectomy.There were eig...     

经颈静脉肝内门体分流术预防门静脉海绵样变食管胃底静脉曲张再出血的临床应用

目的初步评估经颈静脉肝内门体分流术(TIPS)用于预防门静脉海绵样变(CTPV)患者食管静脉曲张再出血的可行性、有效性和安全性。方法选取2011年1月至2016年12月在山东省立医院住院,诊断为CTPV且合并食管静脉曲张出血史,行TIPS预防再出血的患者67例,纳入回顾性分析并随访。总结技术成功率、并发症发生率、再出血、支架通畅、肝性脑病及生存情况。结果在67例CTPV患者中,56例(83.6%)患者成功行TIPS术。单独通过颈静脉入路15例,经颈静脉联合经皮经肝入路33例,经颈静脉联合经皮经脾入路8例。TIPS术后平均门-体静脉压力梯度,从(28.09±7.28)mmHg降至(17.53±6.12)mmHg(P<0.01)。平均随访(23.91±12.35)个月,累计无出血率87.0%,支架通畅率81.5%,肝性脑性发生率27.8%,累计生存率88.9%。11例未成功行TIPS术的患者中死亡4例,再次出血4例。结论TIPS用于预防门静脉海绵样变性患者食管静脉曲张再出血,是一种安全、可行、有效的方法。     

Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein

Background: Treatment options for patients with cavernous transformation of portal vein(CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. Methods: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. Results: TIPS procedure was successfully performed in 56 out of 67(83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone( n = 15), a combined transjugular/transhepatic approach( n = 33) and a combined transjugular/transsplenic approach( n = 8). Mean portosystemic pressure gradient(PSG) decreased from 28.09 ± 7.28 mmHg to 17.53 ± 6.12 mmHg after TIPS( P 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. Conclusions: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement.     

Cavernous transformation of the portal vein associated to multiorgan developmental abnormalities.

Initial diagnosis of cavernous transformation of the portal vein (portal cavernoma) is rarely made in adults. Its main clinical manifestation is upper gastrointestinal hemorrhage due to variceal bleeding. More rarely, diagnosis is made from obstructive jaundice. In children, this condition is frequently associated to prehepatic portal hypertension and congenital anomalies, the most frequent of which are atrial septal defects or malformations of the biliary tract or of the inferior vena cava. We describe here a case of a 23-year-old female presenting with massive hematemesis due to the presence of esophageal and small intestinal varices. She had a cavernous transformation of the portal vein with prehepatic portal hypertension associated with heretofore unreported malformations such as right pulmonary hypoplasia, cardiac dextroposition, and right renal ectopia. A unifying hypothesis (e.g. an intrauterine vascular insult) to explain the pathogenesis of these defects seems unlikely. Appropriate tests failed to identify specific functional abnormalities in these organs. Although she bled more than once, the combination of sclerotherapy and beta-blockers has been, thus far, able to control the major clinical consequences of this disease.     

肝硬化门静脉血栓形成的临床分析

目的　探讨肝硬化 (LC)门静脉血栓 (PVT)形成对LC病程发展的影响。方法　检索我院自 1 995至 2 0 0 2年肝硬化PVT形成患者 ,血栓诊断依据彩色多普勒和 (或 )CT。 4 8例肝硬化PVT形成患者入选血栓组 ;同阶段LC门脉高压症的非血栓病例中选择 5 2例作为对照组。对两组患者的肝功能Child Pugh分级、凝血功能、门静脉、脾静脉宽度及脾脏面积、厚度进行比较。行t检验 ,χ2 检验 ,Logistic回归分析。结果　肝硬化PVT形成除继发于脾切除等手术后 ,75 .0 %隐匿发病 ,85 .4 %的血栓发生于门静脉主干 ,脾脏增大与门静脉增宽是PVT形成的危险因素 (P =0 .0 0 3、0 .0 1 0 )。血栓组门静脉及脾静脉宽度分别为 (1 .4 8± 0 .2 6 )cm ,(1 .2 3± 0 .38)cm ,与对照组比较差异有显著性 [(1 .37± 0 .2 2 )cm ,(1 .0 5± 0 .30 )cm ,P =0 .0 37,0 .0 31 ]。血栓组脾面积平均值为 (96 .6 4± 33.4 )cm2 ,脾厚径为 (6 .0 7± 1 .2 0 )cm ,分别大于对照组的 (80 .81± 2 8.9)cm2 ,(5 .2 3± 1 .0 8)cm(P =0 .0 36 ,0 .0 0 1 )。血栓组食管胃底静脉曲张程度重于非血栓组 ,大出血、大量腹水比例高 (P <0 .0 5 )。血栓形成后 1年内死亡率为1 6 .6 % ,较非血栓组增高 (P =0 .0 2 3)。两组肝功能Child Pugh分级、凝血功能、血小板计     

脾切除贲门周围血管离断术治疗晚期血吸虫病并门静脉海绵样变

目的 目的 探讨晚期血吸虫病门静脉高压症合并门静脉海绵样变的外科治疗方式。 方法 方法 对湖南省血吸虫病防治 所附属湘岳医院18例晚期血吸虫病合并门静脉海绵样变患者的临床资料进行回顾性分析。结果 结果 16例患者行脾切除贲 门周围血管离断术; 2例患者先行内镜食管曲张静脉套扎术, 后因再次食管静脉曲张破裂出血, 分别于术后32、 40个月行脾 切除贲门周围血管离断术。术后随访6～72个月, 未再发现食管胃底静脉曲张。结论 结论 脾切除贲门周围血管离断术适用 于晚期血吸虫病门静脉高压合并门静脉海绵样变的治疗。