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題 名 | Congenital Hepatic Arterioportal Fistula Complicated with Gastrointestinal Bleeding Treated with Transcatheter Embolization: Case Report=先天性肝動脈肝門靜脈間廔管合併胃腸道出血及血管栓塞治療:病例報告 |
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作 者 | 林松聯; 李志明; 江文山; 呂嘉順; 尤昭銘; | 書刊名 | 長庚醫學 |
卷 期 | 22:1 1999.03[民88.03] |
頁 次 | 頁106-110 |
分類號 | 417.6245 |
關鍵詞 | 肝動脈肝門靜脈間廔管; 腸胃道出血; 血管栓塞; Hepatic arterioportal fistula; Gastrointestinal bleeding; Transcatheter embolization; |
語 文 | 英文(English) |
中文摘要 | 兒童先天性肝動脈肝門靜脈間廔管(HAVF)是非常少見的疾病;一般多在3、4個 月大後以肝門靜脈高血壓或吸收不良引起症狀,治療上到目前為止均為外科結紮或切除。本 例被發現有 HAVF 時為 2 天大,是意外發現, 彩色杜普勒發現擴張的肝門靜脈內有動脈血 流;是全世界最年輕的病例。但病人家屬拒作進一步診療。3 年後病人產生黑便,內視鏡發 現胃及十二指腸黏膜充血,但無食道靜脈曲張或胃、十二指腸潰瘍。文獻上曾有肝門靜脈血 流異常引起腸胃道充血,甚至出血的報告。因此我們在血管攝影確定有 HAVF 後,隨即以金 屬作血管栓塞;此為所有患 HAVF 的兒童報告病例中,唯一作非外科侵襲性治療術。病人的 HAVF 血流在栓塞完隔天,1 週、2 週后均告消失,且無血栓塞產生的跡象。 結論是兒童胃 腸不正常出血;包括肝門高血壓引起的食道出血或肝門靜脈異常擴張時有須要作肝門靜脈杜 朴勒( Doppler )檢查; 作血管攝影證實有 HAVF 時,血管栓塞法是一種安全、有效的治 療。 |
英文摘要 | Congenital hepatic arterioportal fistula (HAVF) is extremely rare in children. We present a patient with congenital hepaticoportal arteriovenous fistula complicated with gastrointestinal bleeding treated using transcatheter arterial embolization. Our patient was the youngest (2 days old) case ever reported with congenital HAVF and the first one to receive arterial embolizatioin for HAVF during childhood. The 3-year-old girl was suggested of having congenital HAVF using Doppler ultrasonography. However, her family refused further investigation, and she was lost to follow-up. Three years later, she was sent to our hospital due to melaena. Repeated ultrasonography revealed dilated intrahepatic portal vein with arterial flow demonstrated using Doppler imaging. No esophageal varices or gastric or duodenal ulcer was seen during endoscopy. Angiography showed a HAVF and transcatheter embolization was done simultaneously. Follow-up at one and two weeks post-embolization revealed no more shunt flow within the portal vein, though cystic like dilatation of the portal vein persisted, and no thrombosis was observed. This case emphasizes that transcatheter arterial embolization can be easily and successfully used for treating childhood congenital HAVF. Abnormal dilatation of the portal vein in children needs doppler evaluation and possibly angiography. |
本系統中英文摘要資訊取自各篇刊載內容。