中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2015年
1期
59-62
,共4页
刘江斌%吴琳%郑珊%肖现民
劉江斌%吳琳%鄭珊%肖現民
류강빈%오림%정산%초현민
肝%动静脉瘘%婴儿,新生,疾病%化学栓塞,治疗性
肝%動靜脈瘺%嬰兒,新生,疾病%化學栓塞,治療性
간%동정맥루%영인,신생,질병%화학전새,치료성
Liver%Arteriovenous fistula%Infant,newborn,disease%Chemoembolization,therapeutic
目的 探讨经肝动脉介入栓塞治疗小儿先天性肝脏动静脉瘘的方法及其疗效.方法 回顾性分析2007年4月至2011年2月复旦大学附属儿科医院收治的3例小儿先天性肝脏动静脉瘘的临床资料.其中,例1为男孩,生后3个月因腹部增大2个月入院,B型超声提示大量腹水、肝脏占位;增强CT提示肝脏左叶内异常高密度影;腹水检查为漏出液;例2为男孩,生后5d因黄疸、心影大3d入院,检查发现同时伴房间隔缺损、动脉导管未闭、心功能衰竭及肺动脉高压,增强CT提示肝脏动静脉瘘;例3为女孩,生后6.5个月因上消化道出血入院,伴脾脏肿大和腹壁静脉曲张,上消化道钡餐和胃镜检查提示食管胃底静脉曲张,B型超声检查提示肝脏内靠近肝门部占位,增强CT发现为异常高密度影;3例患儿均采用股动脉穿刺插管肝动脉DSA造影,确诊为先天性肝脏动静脉瘘后给予肝明胶海绵及Fiber coil介入栓塞治疗.结果 3例先天性肝脏动静脉瘘均介入治疗顺利,无术后出血及肝脏功能异常.3例均存活并随访至今.例1术后3周腹水完全消退.例2术后1周黄疸消退,3个月后房间隔缺损现已明显缩小,动脉导管已经闭合;心力衰竭及肺动脉高压消失.例3介入治疗后无消化道出血表现,3个月后检查食管胃底静脉曲张基本消失,脾脏肿大明显减少.3例患儿生长发育均正常.结论 小儿先天性肝脏动静脉瘘是罕见疾病,采用经肝动脉DSA造影和栓塞的介入栓塞治疗方法是治疗小儿先天性肝脏动静脉瘘的有效方法.
目的 探討經肝動脈介入栓塞治療小兒先天性肝髒動靜脈瘺的方法及其療效.方法 迴顧性分析2007年4月至2011年2月複旦大學附屬兒科醫院收治的3例小兒先天性肝髒動靜脈瘺的臨床資料.其中,例1為男孩,生後3箇月因腹部增大2箇月入院,B型超聲提示大量腹水、肝髒佔位;增彊CT提示肝髒左葉內異常高密度影;腹水檢查為漏齣液;例2為男孩,生後5d因黃疸、心影大3d入院,檢查髮現同時伴房間隔缺損、動脈導管未閉、心功能衰竭及肺動脈高壓,增彊CT提示肝髒動靜脈瘺;例3為女孩,生後6.5箇月因上消化道齣血入院,伴脾髒腫大和腹壁靜脈麯張,上消化道鋇餐和胃鏡檢查提示食管胃底靜脈麯張,B型超聲檢查提示肝髒內靠近肝門部佔位,增彊CT髮現為異常高密度影;3例患兒均採用股動脈穿刺插管肝動脈DSA造影,確診為先天性肝髒動靜脈瘺後給予肝明膠海綿及Fiber coil介入栓塞治療.結果 3例先天性肝髒動靜脈瘺均介入治療順利,無術後齣血及肝髒功能異常.3例均存活併隨訪至今.例1術後3週腹水完全消退.例2術後1週黃疸消退,3箇月後房間隔缺損現已明顯縮小,動脈導管已經閉閤;心力衰竭及肺動脈高壓消失.例3介入治療後無消化道齣血錶現,3箇月後檢查食管胃底靜脈麯張基本消失,脾髒腫大明顯減少.3例患兒生長髮育均正常.結論 小兒先天性肝髒動靜脈瘺是罕見疾病,採用經肝動脈DSA造影和栓塞的介入栓塞治療方法是治療小兒先天性肝髒動靜脈瘺的有效方法.
목적 탐토경간동맥개입전새치료소인선천성간장동정맥루적방법급기료효.방법 회고성분석2007년4월지2011년2월복단대학부속인과의원수치적3례소인선천성간장동정맥루적림상자료.기중,례1위남해,생후3개월인복부증대2개월입원,B형초성제시대량복수、간장점위;증강CT제시간장좌협내이상고밀도영;복수검사위루출액;례2위남해,생후5d인황달、심영대3d입원,검사발현동시반방간격결손、동맥도관미폐、심공능쇠갈급폐동맥고압,증강CT제시간장동정맥루;례3위녀해,생후6.5개월인상소화도출혈입원,반비장종대화복벽정맥곡장,상소화도패찬화위경검사제시식관위저정맥곡장,B형초성검사제시간장내고근간문부점위,증강CT발현위이상고밀도영;3례환인균채용고동맥천자삽관간동맥DSA조영,학진위선천성간장동정맥루후급여간명효해면급Fiber coil개입전새치료.결과 3례선천성간장동정맥루균개입치료순리,무술후출혈급간장공능이상.3례균존활병수방지금.례1술후3주복수완전소퇴.례2술후1주황달소퇴,3개월후방간격결손현이명현축소,동맥도관이경폐합;심력쇠갈급폐동맥고압소실.례3개입치료후무소화도출혈표현,3개월후검사식관위저정맥곡장기본소실,비장종대명현감소.3례환인생장발육균정상.결론 소인선천성간장동정맥루시한견질병,채용경간동맥DSA조영화전새적개입전새치료방법시치료소인선천성간장동정맥루적유효방법.
Objective To explore the efficacies and outcomes of embolization in the treatment of infant and neonatal congenital intrahepatic arteriovenous shunt.Methods Three cases of infant and neonatal congenital intrahepatic arteriovenous shunt from April 2007 to February 2011 were retrospectively reviewed.One boy aged 3 months had abdominal distension caused by massive ascite.And another 5-day-old boy had jaundice,atrial septal defect/patent ductus arteriosus and heart failure/ pulmonary hypertension.A 6.5-month-old girl was referred for severe upper gastrointestinal bleeding and melena.Splenomegaly and varicose veins were also noted on abdominal wall.Doppler ultrasonography and enhanced computed tomography (CT) suggested the presence of intrahepatic hepatoportal or arteriovenous shunts in all 3 cases.Transarterial embolization was successfully achieved by coiling of hepatic artery in all cases.Results The shunts were blocked by gelfoam and fiber coil.And ascite disappeared spontaneously within 3 weeks after embolization for case 1.For case 2,atrial septal defect/patent ductus arteriosus closed and heart failure/pulmonary hypertension disappeared.And upper gastrointestinal tract bleeding and melena disappeared in case 3.All patients survived and recovered well.Conclusions Congenital intrahepaticl arteriovenous shunt is rare and transarterial embolization may be an excellent curative option.
