1例门静脉血管瘤致梗阻性黄疸并Glisson鞘出血的诊断及治疗分析

发布时间：2018-02-21 06:15

本文关键词： 血管瘤门静脉血管瘤黄疸梗阻性黄疸血管瘤破裂 Glisson鞘胆管支架置入术磁共振胰胆管成像内镜逆行胰胆管造影术　出处：《山东医药》2017年43期 　论文类型：期刊论文

【摘要】：探讨门静脉血管瘤致梗阻性黄疸并Glisson鞘内出血的诊断及治疗方法。方法对1例门静脉血管瘤致梗阻性黄疸并Glisson鞘出血患者的临床资料作回顾性分析。结果患者因中上腹疼痛2 d就诊,CT和磁共振成像(MRI)检查示门静脉右支局限性不规则扩张血管瘤;CT门脉期和门脉重建影像于血管瘤下缘见椭圆形囊状低密度影,内见部分强化,肝内可见条索状和点状高密度影;磁共振胰胆管成像(MRCP)于肝门部胆管见一外压形狭窄。诊断为门静脉血管瘤致梗阻性黄疸并血管瘤破裂Glisson鞘内出血。内镜逆行胰胆管造影术(ERCP)术中见肝门部胆管狭窄,导丝进入肝内胆管时易折回,调整方向后进入肝内胆管造影示肝内胆管扩张,后沿导丝置入塑料支架,次日复查胆红素下降约30%,且临床症状好转,后期胆红素水平在低值附近波动,血红蛋白、血浆前白蛋白水平逐渐升高,1个月后胆红素水平基本正常。结论影像学检查,尤其是CT、MRI及MRCP检查,是门静脉血管瘤、梗阻性黄疸、血管瘤破裂Glisson鞘内出血的主要诊断手段,ERCP支架置入术是治疗本病的一种较好的方法。
[Abstract]:To investigate the diagnosis and treatment of obstructive jaundice caused by portal vein hemangioma and intrathecal hemorrhage of Glisson. Methods A case of obstructive jaundice caused by portal vein hemangioma with Glisson sheath hemorrhage was retrospectively analyzed. Ct and magnetic resonance imaging (MRI) examination showed that the portal vein phase and portal vein reconstruction images of the right portal vein dilated hemangioma in the inferior margin of the hemangioma showed oval cystic low density imaging, and the right portal vein was dilated irregularly in the right portal vein of the portal vein on the lower margin of the hemangioma. Part of the enhancement was seen in the liver and high density shadows were seen in the liver. Mr cholangiopancreatography (MRCP) showed an external pressure stenosis in the hilar bile duct. It was diagnosed as obstructive jaundice caused by portal hemangioma and hemorrhage in the Glisson sheath of the hemangioma ruptured. Endoscopic retrograde cholangiopancreatography (ERCP) showed the hepatic hilar bile duct stricture during the operation. When the lead wire enters the intrahepatic bile duct, it is easy to turn back. After adjusting the direction, the intrahepatic bile duct dilatation is indicated, and the plastic stent is placed along the guide wire. The bilirubin decreases by about 30% the next day, and the clinical symptoms are improved. The bilirubin level fluctuated near the low value in the later stage, hemoglobin and plasma prealbumin level increased gradually, bilirubin level was basically normal after one month. Conclusion Imaging examination, especially CT MRI and MRCP, is portal vein hemangioma, obstructive jaundice. The main diagnostic method of hemangioma ruptured intrathecal hemorrhage (Glisson) is that stenting is a better method for the treatment of hemangioma.
【作者单位】：苏州大学附属第一医院;
【分类号】：R575

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