Fatal Arterioportal Shunting in a Case of Hepatocellular Carcinoma with Spontaneous Partial Regression of Malignant Portal Vein Thrombosis

肝癌肝門靜脈栓塞自然消失後引發肝門靜脈高壓及併發症：一病例報告

周業彬(Yeh-Pin Chou) ； 李佩倫(Pei-Lun Lee) ； 鄭汝汾(Yu-Feng Cheng) ； 盧勝男(Sheng-Nan Lu) ； 張簡吉幸(Chi-Sin Changchien) ； 王景弘(Jing-Houng Wang)

《臺灣消化醫學雜誌》 20卷4期 (2003/12) Pp. 245-251

https://doi.org/10.6557/GJT.200312_20(4).0002

摘要

肝門靜脈栓塞在肝癌病人並不少見，但肝門靜脈栓塞自然消失及其併發症並無報告。我們報告一位二十七歲男性肝癌病人合併肝門靜脈栓塞，診斷後四十五天超音波追蹤發現肝門靜脈栓塞自然部份消失且合併腹水產生，杜卜勒超音波偵測發現離肝血流從肝門靜脈右支流向肝主門靜脈，頻譜分析發現離肝血液為脈動波型。肝門靜脈栓塞發生自然部份消失機轉並不明瞭，但肝門靜脈栓塞自然部份消失後引發顯著的肝動脈肝門靜脈分流，進而昇高的肝門靜脈壓，並引發肝門靜脈高壓併發症。雖經導管肝動脈栓塞嘗試關閉肝動脈肝門靜脈分流，但因多發性的肝動脈肝門靜脈分流使經導管肝動脈栓塞只得到暫時的緩解。

關鍵字

自然消失 ； 肝細胞癌 ； 肝門靜脈栓塞 ； 肝動脈肝門靜脈分流

並列摘要

The portal-invasing hepatocellular carcinoma (HCC) and arterioportal (AP) shunting are not rare in patients with HCC. But a fatal complication of AP shunting and spontaneous partial regression of malignant portal vein thrombosis (PVT) are rely rare. In one patient, portal vein invasion of HCC was diagnosed by fine needle aspiration cytology. Computed tomography demonstrated portal vein thrombosis and angiography showed thread and streaks sign. Follow-up duplex Doppler studs 45 days later alter diagnosis revealed spontaneous partial regression of thrombus is with obvious arterioportal shunting and hepatofugal flow. Due to increased portal pressure from arterioportal shunting and regression of PVT, the patient suffered from ascites, hepatic encephalopathy, and episodic acute variceal bleeding. Transcatheter arterial embolization of arterioportal shunting and esophageal variceal banding ligation provided only temporary effect. Finally, he expired due to uncontrolled varices bleeding.

並列關鍵字

spontaneous regression ； hepatocellular carcinoma ； portal vein thrombosis ； arterioportal shunting