摘要
門靜脈血管瘤是臨床上少見之靜脈血管病變，臺灣過去並無相關病歷報告。其發生原因可為先天的靜脈血管內壁破壞，卵黃靜脈在胚胎期發育不正常；或後天因胰臟炎，或門脈高壓所致。小型門靜脈血管瘤多無症狀，唯若持續變大，則可壓迫十二指腸，總膽管，或出現黃疸，肝脾腫大，門脈高壓，血栓，及靜脈瘤破裂之發生。門靜脈血管瘤之處理包括追蹤觀察，手術治療，或門靜脈減壓術。吾等報告一73歲男性，因主訴倦怠，虛弱，及上腹不適至本院求診。於門診腹部超音波檢查發現一疑似肝臟腫瘤而入院接受診治。後經腹部都蔔勒超音波，電腦斷層，及血管攝影檢查等均證實有一3.2x2.2x2.2公分之靜脈瘤位於肝內部門靜脈交匯處，且病灶內有亂流存在，而確定為罕見之門靜脈瘤。其發生原因並不清楚。其臨床症狀雖於入院後改善，但似與本症無直接關連。由於該病灶並未造成臨床症狀如門脈高壓，或十二指腸及膽管受壓迫等情形，閉刀手術應無必要，故建議出院後於門診追蹤。
並列摘要
Although venous abnormalities of the portal system have been thoroughly investigated in literature, an aneurysm of the portal vein is especially uncommon in clinical practice in Taiwan. We investigated a 73-year-old male patient who complained of malaise, fatigue, and abdominal discomfort for three months. Abdominal ultrasound at O.P.D. demonstrated that the patient has a large anechoic area at the bifurcation of portal vein with turbulent flows inside. Therefore he was admitted for further study. A number of examinations including CT scanning, Color Doppler ultrasound, and angiography were conducted, and all proved the abnormality to be a portal vein aneurysm. Portal vein aneurysms (PVAs) may be intrahepatic or extrahepatic, and their origin may be congenital or acquired. Acquired lesions are associated with trauma, degenerative changes or liver disease. Portal vein aneurysms. if large, are likely to give rise to symptoms of duodenal compression, common bile duct obstruction, and chronic portal hypertension. Ultrasound is the most common and easiest method for diagnosing aneurysms of the portal system. Managements of PVAs usually include observation, resection, thrombectomy, or portal venous decompression.
延伸閱讀
- Chin, C. H., Lai, Y. F., Wong, S. L., Ko, S. F., & Hsieh, M. J. (2002). 自發性栓塞性奇靜脈囊狀瘤：病例報告. 胸腔醫學, 17(2), 154-158. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200206-17-2-154-158-a
- Liao, C. H., Sy, L. B., & Tsou, K. I. (2003). 臍靜脈導管放置異常：一病例報告. Acta Paediatrica Taiwanica, 44(1), 38-40. https://doi.org/10.7097/APT.200302.0038
- 呂佳穎、吳定國、王建國、劉金昌（2002）。大型週邊動靜脈畸型經動脈血管栓塞術：二個病例報告。中華放射線醫學雜誌，27(3)，123-128。https://www.airitilibrary.com/Article/Detail?DocID=10188940-200206-27-3-123-128-a
- Tsai, C. H., Mao, Y. C., Tsan, Y. T., Hu, S. Y., & Wang, L. M. (2009). 敗血性內頸靜脈血栓靜脈炎（Lemierre氏症候群）：一病例報告. 中華民國急救加護醫學會雜誌, 20(3), 121-127. https://doi.org/10.30018/JECCM.200909.0003
- 王局文、鄭明德（1993）。異位性獲化合併血管壓迫－病例報告。中華民國復健醫學會雜誌，(21)，201-205。https://www.airitilibrary.com/Article/Detail?DocID=10253009-199312-x-21-201-205-a