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门静脉高压病人发生静脉曲张常见的部位是食管和胃。但亦发生在十二指肠,小肠、结肠、直肠和远端胆道。本文报告两例门静脉阻塞所致的胆总管和总肝管静脉曲张:例1、64岁、男、有胰腺炎多次发作和糖尿病史。临床上无门静脉高压体征,口服和静脉胆道造影胆囊均不显影。术中发现胆囊结石行胆囊切除术。术后第9天静脉胆道造影见胆总管远端有数处固定充盈缺损并经经皮肝穿刺胆道造影证实。胆总管探查发现一条1.5 cm弯曲静脉跨过胆总管,穿刺胆总管抽出血液,胆道镜下看到多条2～3mm蒂状血管进入胆总管。“T”管造影显示胆总管、总肝管内侧多处界限清楚的切迹状充盈缺损。动脉造影可见脾和肠系膜上静脉阻塞,胆道充盈缺损处有多条扩张的侧枝静脉。无食管、胃静脉曲张。例2、39岁、男、有食管静脉曲张出血史和胃溃疡病史。临床上除明显的脾
Portal hypertension occurs in patients with varicose veins common parts of the esophagus and stomach. But also in the duodenum, small intestine, colon, rectum and distal biliary tract. This article reports two cases of common bile duct and total hepatic duct varices due to portal vein obstruction: a case of age 1, 44, male with multiple episodes of pancreatitis and a history of diabetes. Clinically no signs of portal hypertension, oral and intravenous cholangiography gallbladder were not developed. Intraoperative gallbladder stones were found cholecystectomy. On the 9th day after intravenous cholangiogram, there were several fixed filling defects in the distal common bile duct and confirmed by percutaneous transhepatic cholangiography. Common bile duct exploration found a 1.5 cm curved veins across the common bile duct, punctured the common bile duct to extract blood, see a number of cholecystectomy 2 ~ 3mm pedicle blood vessels into the common bile duct. “T” tube angiography showed the common bile duct, the total number of hepatic duct medial clear cut-notch fill defects. Arteriography showed splenic and superior mesenteric vein occlusion, biliary filling defect at the expansion of the collateral vein. No esophageal, gastric varices. Cases 2,39 years old, male, history of esophageal variceal bleeding and gastric ulcer. In addition to the clinical obvious spleen