Agustos 2010
Portal biliopati?de Doppler ultrasonografi ile kolanjiografi bulgulari ilişkisizdir
Doppler ultrasound findings are unrelated to cholangiographic findings in patients with portal biliopathy
- Ana Sayfa
- Sayılar
- Agustos 2010
- Portal biliopati?de Doppler ultrasonografi ile kolanjiografi bulgulari ilişkisizdir...
Özet
Giriş ve Amaç: Portal ven trombozu ve portal ven kavernomatöz transformasyonu gelişen hastalarda ortaya çikan safra yolu degisıklıklerine portal biliopati denmektedir. Portal biliopati, ekstrahepatik safra yollarini, intrahepatik safra yollarini veya hem ekstra hem intrahepatik safra yollarini tutabilmektedir. Bu çalışmanın amacı portal ven trombozu ve portal ven kavernomatöz transformasyonu olan hastalarda Doppler ultrasonografi bulgularının safra yollarinin farkli düzeylerdeki tutulumunu açiklayip açiklayamayacagini saptamaktir. Gereç ve Yöntem: Safra yolu tikanikligi bulgulari ile endoskopik retrograd kolanjiopankreatografi yapılan portal biliopatili 22 olgunun (15 erkek, 7 kadın, ortalama yaş 40,28±12,02 yıl) Doppler ultrasonografi bulgulari, endoskopik retrograd kolanjiopankreatografi bulgularindan haberdar olmayan radyolog tarafindan saptandi ve her iki yöntemin bulgulari kıyaslandi. Sag ve sol intrahepatik safra yollarina, ekstrahepatik safra yollarina komsu kollaterallerin varligi, endoskopik retrograd kolanjiopankreatografi ile saptanan kolanjiografi bulgulari ile karsilastirildi. Bulgular: Endoskopik retrograd kolanjiopankreatografi?de ekstrahepatik safra yollarinda tüm hastalarda, sag intrahepatik safra yollarinda 3 hastada, sol intrahepatik safra yollarinda 2 hastada (sag intrahepatik safra yollari tutulu olan 3 hastanın 2?si) darlik vardı. Önemli bir hasta grubunda intrahepatik safra yollarina komsu kollateraller olduğu halde safra yolu darligi olmadigi saptandi: Doppler ultrasonografi?de ekstrahepatik safra yollarina komsu tüm hastalarda, sag intrahepatik safra yollarina komsu 12 hastada (safra yolu darligi olan 3 hasta dahil), sol intrahepatik safra yollarina komsu 9 hastada (safra yolu darligi olan 2 hasta dahil) kollateraller vardı. Sonuç: Doppler ultrasonografi ile saptanan portal ven ve kollaterallere ait bulgular, safra yolu tutulum düzeyi ile korelasyon göstermez. Bu bulgu, portal biliopati patogenezinde sadece kollateral basisinin degil, baska faktörlerin de rol oynadığıni desteklemektedir.
Abstract
Background and Aims: Biliary changes caused by cavernous transformation, which develops after portal vein thrombosis, are referred to as portal biliopathy. It may involve extrahepatic or intrahepatic bile ducts, or both. We aimed to reveal whether findings on Doppler ultrasound are related to changes seen on cholangiography in patients with portal vein thrombosis who developed cavernous transformation. Materials and Methods: A total of 22 patients [15 males, mean age 40,28±12,02 years] with portal biliopathy who underwent endoscopic retrograde cholangiopancreatography procedure for the relief of biliary obstruction were examined with Doppler ultrasound by radiologists who were blinded to the endoscopic retrograde cholangiopancreatography findings. The data from both examinations were compared, particularly the relationship of extrahepatic and intrahepatic main bile ducts with the site of thrombosis and the presence of collaterals. Results: We found biliary strictures in the right hepatic duct in 3 patients, in the left hepatic duct in 2 patients and in the extrahepatic bile ducts in all patients by endoscopic retrograde cholangiopancreatography. On the other hand, Doppler ultrasound showed that a significant number of patients had no biliary stricture even in the presence of dilated collateral veins accompanying the bile ducts (next to the extrahepatic bile duct in all patients, to the right hepatic duct in 12 patients and to the left hepatic duct in 9 patients). Conclusions: We found that there was no relation between the Doppler ultrasound findings of portal veins and collaterals and the site of the stricture detected by endoscopic retrograde cholangiopancreatography. It may be concluded that there are some factors other than compression of collateral veins that play a role in the pathogenesis of portal biliopathy.
