中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2012年
9期
620-624
,共5页
朱晚林%陈韶华%陈卫星%厉有名
硃晚林%陳韶華%陳衛星%厲有名
주만림%진소화%진위성%려유명
肝静脉闭塞性疾病%生物碱类%中草药%活组织检查,针吸%抗凝药
肝靜脈閉塞性疾病%生物堿類%中草藥%活組織檢查,針吸%抗凝藥
간정맥폐새성질병%생물감류%중초약%활조직검사,침흡%항응약
Hepatic veno-occlusive disease%Alkaloids%Drugs,Chinese herbal%Biopsy,needle%Anticoagulants
目的 分析肝小静脉闭塞病(HVOD)的临床特点,探讨其诊断及治疗方法.方法 分析浙江大学医学院附属第一医院2008年8月至2011年8月收治的50例HVOD患者的病因、临床表现、实验室检查、影像学表现、病理特点及治疗情况.结果 50例HVOD患者中,38例有服用土三七史,占76％,临床表现主要为腹水、肝大、肝区疼痛、黄疸及体质量增加.实验室检查显示,肝功能损害,血CA125升高.超声示肝大、肝静脉变细,血流减慢；CT示肝外形饱满,增强扫描示门脉期及延迟期肝实质不均匀强化,呈地图样改变,肝静脉明显变细.病理检查示肝窦充血,中央静脉狭窄、管壁增厚.主要采取抗凝治疗,1例治愈,33例好转,13例未愈,3例死亡.结论 浙江省因服用土三七而引起HVOD的病例较多见,可根据病史、临床表现和特征性的影像学表现来明确诊断,但不典型病例仍需肝活组织穿刺检查.采用抗凝治疗能取得较好疗效.
目的 分析肝小靜脈閉塞病(HVOD)的臨床特點,探討其診斷及治療方法.方法 分析浙江大學醫學院附屬第一醫院2008年8月至2011年8月收治的50例HVOD患者的病因、臨床錶現、實驗室檢查、影像學錶現、病理特點及治療情況.結果 50例HVOD患者中,38例有服用土三七史,佔76％,臨床錶現主要為腹水、肝大、肝區疼痛、黃疸及體質量增加.實驗室檢查顯示,肝功能損害,血CA125升高.超聲示肝大、肝靜脈變細,血流減慢；CT示肝外形飽滿,增彊掃描示門脈期及延遲期肝實質不均勻彊化,呈地圖樣改變,肝靜脈明顯變細.病理檢查示肝竇充血,中央靜脈狹窄、管壁增厚.主要採取抗凝治療,1例治愈,33例好轉,13例未愈,3例死亡.結論 浙江省因服用土三七而引起HVOD的病例較多見,可根據病史、臨床錶現和特徵性的影像學錶現來明確診斷,但不典型病例仍需肝活組織穿刺檢查.採用抗凝治療能取得較好療效.
목적 분석간소정맥폐새병(HVOD)적림상특점,탐토기진단급치료방법.방법 분석절강대학의학원부속제일의원2008년8월지2011년8월수치적50례HVOD환자적병인、림상표현、실험실검사、영상학표현、병리특점급치료정황.결과 50례HVOD환자중,38례유복용토삼칠사,점76％,림상표현주요위복수、간대、간구동통、황달급체질량증가.실험실검사현시,간공능손해,혈CA125승고.초성시간대、간정맥변세,혈류감만；CT시간외형포만,증강소묘시문맥기급연지기간실질불균균강화,정지도양개변,간정맥명현변세.병리검사시간두충혈,중앙정맥협착、관벽증후.주요채취항응치료,1례치유,33례호전,13례미유,3례사망.결론 절강성인복용토삼칠이인기HVOD적병례교다견,가근거병사、림상표현화특정성적영상학표현래명학진단,단불전형병례잉수간활조직천자검사.채용항응치료능취득교호료효.
Objective To analyze the clinical features of hepatic veno-occlusive disease (HVOD) and to explore the diagnosis criteria and treatment.Methods A total of 50 cases of HVOD administrated at The First Affiliated Hospital of College of Medicine,Zhejiang University from August 2008 to August 2011 were analyzed for etiology,clinical manifestation,laboratory examination,image,pathological features and treatment.Results Among the 50 HVOD cases,38 cases (76％)had a history of taking Gynura segetum.The main clinical manifestations were ascites,hepatomegaly,right upper quadrant pain,jaundice,and weight gain.Laboratory examinations indicated liver function injury and increased serum CA125 level.Color Doppler ultrasound showed hepatomegaly,decrease in diameter of hepatic vein and slow blood flow.The computed tomography scan suggested hepatomegaly,enhanced scan showed liver inhomogeneous enhancement at portal and delayed phase,map-like changes and markedly decrease in diameter of hepatic vein.Pathological examination suggested hepatic sinusoid congestion,central vein stenosis and vessel wall thickening.The main therapy was anticoagulant treatment.One case cured,33 cases improved,13 cases uncured and three cases died.Conclusions HVOD because of taking Gynura segetum is common in Zhejiang Province,which can be diagnosed according to medical history,clinical manifestations, and typical image characteristic.However,diagnosis of the atypical cases still needs liver biopsy.Anticoagulation therapy can achieve better efficacy.
