Abstract：
BACKGROUND: Portal hypertensive biliopathy (PHB) was caused by anatomical and functional abnormalities in the intrahepatic and extrahepatic bile ducts secondary to portal hypertension. Currently, there is no consensus regarding to the optimal treatment for PHB. Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment choice for the management of symptomatic PHB, however, it could be very difficult in patients with PHB and cavernous transformation of portal vein.
METHODS: We report a case of PHB, successfully managed with TIPS. A 23-year-old man with liver cirrhosis presented with jaundice. Magnetic resonance cholangiopancreatography (MRCP) showed multiple tortuous hepatopetal collateral vessels compressing the common bile duct (CBD) and leading to the dilated proximal bile duct. He was diagnosed with PHB and treated with TIPS. A guidewire was inserted into the appropriate collateral vessel through transsplenic approach to guide intrahepatic puncture and TIPS was performed successfully. After the operation, portal vein pressure decreased and the symptoms of biliary obstruction were relieved significantly. In addition, the patient showed no jaundice at a follow-up of one year.
CONCLUSIONS: For PHB patients presenting for cavernous transformation of the portal vein, which precludes the technical feasibility of TIPS, a combined transjugular/transsplenic approach could be an alternative option.
METHODS: We report a case of PHB, successfully managed with TIPS. A 23-year-old man with liver cirrhosis presented with jaundice. Magnetic resonance cholangiopancreatography (MRCP) showed multiple tortuous hepatopetal collateral vessels compressing the common bile duct (CBD) and leading to the dilated proximal bile duct. He was diagnosed with PHB and treated with TIPS. A guidewire was inserted into the appropriate collateral vessel through transsplenic approach to guide intrahepatic puncture and TIPS was performed successfully. After the operation, portal vein pressure decreased and the symptoms of biliary obstruction were relieved significantly. In addition, the patient showed no jaundice at a follow-up of one year.
CONCLUSIONS: For PHB patients presenting for cavernous transformation of the portal vein, which precludes the technical feasibility of TIPS, a combined transjugular/transsplenic approach could be an alternative option.
摘要：
背景：门脉高压性胆管病（PHB）是由继发于门脉高压的肝内和肝外胆管的解剖和功能异常引起的。目前,关于PHB的最佳治疗尚无共识。经颈静脉肝内门体分流术（TIPS）是有症状的PHB的治疗选择，然而,PHB和门静脉海绵样变的患者可能非常困难。
方法：我们报告一例PHB，成功管理与TIPS。一名23岁的肝硬化患者出现黄疸。磁共振胰胆管造影（MRCP）显示多个曲折的肝叶侧支血管压迫胆总管（CBD）并导致扩张的近端胆管。他被诊断出患有PHB并接受TIPS治疗。通过经脾入路将导丝插入适当的侧支血管以引导肝内穿刺，并成功进行了TIPS。手术后,门静脉压力下降，胆道梗阻症状明显缓解。此外,随访1年,患者未出现黄疸.
结论：对于表现为门静脉海绵样变的PHB患者，这排除了TIPS的技术可行性，经颈静脉/经脾联合入路可能是另一种选择.
方法：我们报告一例PHB，成功管理与TIPS。一名23岁的肝硬化患者出现黄疸。磁共振胰胆管造影（MRCP）显示多个曲折的肝叶侧支血管压迫胆总管（CBD）并导致扩张的近端胆管。他被诊断出患有PHB并接受TIPS治疗。通过经脾入路将导丝插入适当的侧支血管以引导肝内穿刺，并成功进行了TIPS。手术后,门静脉压力下降，胆道梗阻症状明显缓解。此外,随访1年,患者未出现黄疸.
结论：对于表现为门静脉海绵样变的PHB患者，这排除了TIPS的技术可行性，经颈静脉/经脾联合入路可能是另一种选择.
