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| 概要 |
A 74-year-old noncirrhotic woman presented with abdominal distension and pain in the right hypochondrium. Contrast-enhanced computed tomography (CT) demonstrated multiple large simple liver cysts occu...pying the right lobe of the liver, the largest of which was 19 cm in diameter. Gastric varices were enhanced in the fundus of the stomach. The patient underwent surgery to deroof the hepatic cysts with ablation using argon beam coagulation. Esophagogastroduodenoscopy (EGD) showed that the portal hypertensive gastropathy was ameliorated after the operation ; however, the fundal varices were only slightly decreased. After the operation, we observed that the hepatic vein waveform gradually changed from a gently curved pattern to a normal triphasic pattern. We treated the fundal varices with balloon-occluded retrograde transvenous obliteration 3 months after the initial operation.We describe our successful treatment of this rare case and discuss the utility of hepatic vein waveform analysis in the study of portal hypertension.
患者は，74 歳女性で，右側部痛を主訴に来院，腹部造影CT にて，巨大な多発肝囊胞(最大径19cm)を認め，肝右葉の大部分を占めていた．また同時に胃静脈瘤(穹窿部)を認めた．肝囊胞に対して，開窓術+APC による焼灼術を施行した．上部消化管内視鏡検査では，門脈圧亢進症性胃症の改善は認めるものの，胃静脈瘤の形態的な縮小は軽度であった．肝静脈波型は，吸気呼気に一致したなだらかなカーブパターンから，I 型まで変化し，正常化した．最終的には胃静脈瘤に対して，B-RTO を施行し，胃静脈瘤は消失した．非肝硬変患者の多発する巨大肝囊胞による胃静脈瘤の1治療例を報告し，同時に門脈圧亢進症研究における肝静脈波型の有用性に関して，報告する．続きを見る
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