- 期刊
超音波掃描在肝門靜脈之應用
Detecting Portal Vein Thrombosis by Using Ultrasonography
摘要
超音波檢查(Ultrasonography, US)爲診斷肝臟病變的重要影像工具，配合彩色杜普勒或以即時性超音波導引可協助細胞學或組織學檢體的獲取常可做出明確診斷。一位年約59歲的男性病患有B型肝炎與原發性肝癌的病史，因爲消化不良且持續發燒兩週而經由急診入院，當時所做的超音波檢查(US)及電腦斷層檢查(Computer tomography, CT)發現整個門靜脈(portal vein, PV)及其分枝都已完全阻塞(total thrombosis of main portal vein and its bilateral intrahepatic branches)，並有其他肝內腫瘤。病人接受了左側門靜脈(left portal vein, LPV)的超音波引導切 片檢查(ultrasound-guided biopsy)，病理報告證實爲原發性肝癌(hepatocellular carcinoma, HCC)。使用US偵測肝門靜脈栓塞的準確度曾被報告達94%，高於CT的76%與血管攝影的91%[1]。US所具備的各種特性，使US相較於CT、血管攝影(angiography)等其他影像學工具，對於患者來說，是一種相對經濟便捷且易被接受的檢查。但正確診斷腫瘤的門靜脈栓塞仍依賴組織病理檢查，而US導引對栓塞作細針切片檢查則是最方便且安全的證實步驟，本文據此報告其價值。
並列摘要
Ultrasonography (US) is one of the most important imaging modalities to detect and evaluate hepatic pathology. In conjunction to color Doppler US and US-guided aspiration cytology or needle biopsy, an accurate diagnosis can be frequently obtained. A 59-year-old man with a past history of hepatitis B is a victim of hepatocellular carcinoma (HCC). He complained of intermittent high fever for more than 2 weeks, and came to our hospital for help due to dyspepsia. Ultrasonography (US) and computed tomography (CT) were performed and total thrombosis of main portal vein and its bilateral intrahepatic branches was found. Two small tumors were depicted in the right lobe of the liver. The patient received a US-guided biopsy of the left portal vein thrombus, HCC was confirmed by histopathological study. Ultrasonography (US) is widely used in the evaluation of liver pathology. Its ability to detect the portal vein thrombosis is well documented with an accuracy of 94%. This is higher than that from CT (76%) and angiography (91%). US is a more convenient and cost-efficient modality for this purpose. However, a diagnosis of tumor thrombus still relies on a histological study. We herein report such a case in whom a definite diagnosis of tumor thrombus from HCC was made by using US-guided aspiration biopsy on the left main branch of the portal vein. The usefulness of US, color Doppler US, and US-guided aspiration, biopsy is discussed.