中国典型病例大全

门脉高压性胆病（portal hypertensive biliary,PHB）是继发于门静脉高压的胆道系统病变，常因与胆道原发病交织导致诊断困难。本研究报道1例78岁男性PHB合并胆管癌、胆道钩虫感染及胆道出血的罕见复杂病例：患者因纳差、皮肤巩膜黄疸4月余入院，入院后全腹增强CT提示胆管恶性肿瘤伴肝内多发转移、门静脉主干及左右支多发癌栓、门静脉海绵样变，生化检查示胆汁淤积指标显著升高。为明确胆管内病变并行精准治疗，予行经内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）联合eyeMax胆胰成像系统胆道内探查，镜下见十二指肠大乳头处有活钩虫虫体流出，胆总管下段大量血凝块、中上段隆起型病变伴活动性渗血，随即植入圣诞树支架引流，术后予驱虫治疗。术后患者无腹痛、消化道出血等并发症，总胆红素明显下降后顺利出院，随访示患者精神状态好转、腹痛症状消失。本例证实，eyeMax可视化检查可清晰呈现多病因叠加的胆道病变特征，为PHB合并多种胆道疾病的复杂病例提供精准诊断依据，进而指导个体化治疗方案制定，对改善患者预后具有重要临床价值。

Portal hypertensive biliary disease(PHB) refers to biliary tract lesions secondary to portal hypertension, the diagnosis of which is often challenging due to overlap with primary biliary tract diseases. This article reports a rare and complex case of a 78-year-old male with PHB complicated by cholangiocarcinoma, biliary hookworm infection, and biliary tract hemorrhage. The patient was admitted to the hospital with a 4-month history of anorexia and skin and scleral jaundice. Abdominal enhanced computed tomography(CT) after admission revealed a cholangiocarcinoma with multiple intrahepatic metastases, multiple tumor thrombi in the main portal vein and its left and right branches, and cavernous transformation of the portal vein. Biochemical examinations showed a significant elevation in cholestatic markers. To clarify intraductal lesions and implement precise treatment, endoscopic retrograde cholangiopancreatography(ERCP) combined with the eyeMax cholangiopancreatic imaging system was performed for intrabiliary exploration. Under endoscopy, live hookworms were seen emerging from the major duodenal papilla, a large quantity of blood clots was observed in the lower segment of the common bile duct, and an elevated lesion with active oozing was detected in the middle and upper segments. A Christmas tree stent was then implanted for biliary drainage, and anthelmintic therapy was initiated postoperatively. The patient developed no complications such as abdominal pain or gastrointestinal bleeding after the procedure; his total bilirubin level decreased significantly, and he was discharged smoothly. Follow-up showed that the patient's mental state improved and his abdominal pain resolved. This case confirms that the eyeMax cholangiopancreatic imaging system can clearly visualize the features of biliary tract lesions caused by multiple etiologies, providing accurate diagnostic evidence for complex cases of PHB associated with multiple biliary comorbidities, thereby guiding the formulation of individualized treatment plans and holding important clinical value for improving patient outcomes.