门脉高压致膀胱静脉曲张一例报告并文献分析

Vesical varices as a complication of liver cirrhosis and portal hypertension （a case report and literature analysis）

目的提高对门静脉高压所致膀胱静脉曲张临床诊治特点的认识。方法患者男，63岁。间断无痛性全程肉眼血尿7个月入院。既往肝硬化病史9年。查体未见阳性体征。实验室检查血小板56×10^9／L。超声检查示脾大（5．8cm×14．0cm）；膀胱左侧壁和前壁可见一内部充满静脉血流信号的网状结构（7．0cm×2．4cm），向膀胱左侧外上方延伸，与一粗大静脉血管相连。膀胱镜下可见左侧壁和前壁的曲张静脉血管（3．0cm×5．0cm）。CT血管重建检查示膀胱曲张血管与肠系膜下静脉相连，最终汇入脾静脉。患者临床诊断为肝硬化、门静脉高压、膀胱静脉曲张。行膀胱周围血管离断术治疗。结果患者手术过程顺利，术后血尿症状消失，1个月后复查超声膀胱结构正常。结论肝硬化门静脉高压患者可发生膀胱静脉曲张，膀胱周围血管离断手术治疗效果满意。

Objective Improve understanding the clinical features of bladder varices with portal hypertension. Methods A 63-year-old male manifested seven episodes of painless gross hematuria and bad a 9-year history of liver cirrhosis. Physical examination was unremarkable. There was thrombocytopenia of 56 × 10^9/L. Ultrasound showed splenomegaly . Cystoscopy revealed a 3.0 cm× 5.0 cm sized hemangiomatous on the left lateral and anterior wall of the bladder. Computed tomography angiography revealed the vesical varicose veins flowing into the inferior mesenteric vein and then to the splenic vein. Results The patient was diagnosed vesical varices, liver cirrhosis and portal hyperten- sion. Performed perivesical devascularization and in ultrasound one month after the operation the varices disappears . Conclusion Vesical varices can occur in liver cirrhosis and portal hypertension patients without history of abdominal and pelvic operation, and can be treated by perivesical devascularization.