解放军医学院学报
解放軍醫學院學報
해방군의학원학보
Academic Journal of Chinese Pla Medical School
2013年
1期
34-36
,共3页
丁鹏鹏%张杜超%王娟%刘迎娣
丁鵬鵬%張杜超%王娟%劉迎娣
정붕붕%장두초%왕연%류영제
肝窦阻塞综合征%诊断%治疗
肝竇阻塞綜閤徵%診斷%治療
간두조새종합정%진단%치료
sinusoidal obstruction syndrome%diagnosis%therapy
目的总结肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,HSOS)的临床特点,提高对该病的认识.方法回顾性分析解放军总医院23例HSOS的临床资料.结果23例中8例(34.7%)近期曾服用中药(其中4例含有土三七),2例(8.7%)接受化疗及免疫抑制剂治疗,2例(8.7%)服用镇痛药(含非甾体类药物),11例(47.9%)无明确诱因.临床主要表现为腹水(78.3%)、腹胀(73.9%)、肝大(21.7%)、肝区疼痛(26.1%)、黄疸(17.4%),有不同程度的肝功能受损.B超检查见肝质地回声增粗、分布不均,呈“斑片状”,肝静脉显示不清或明显变细,血流降低或消失,肝段下腔静脉多表现为受压变细;增强CT示肝脏呈“地图状”强化不均匀;血管造影显示肝静脉远端小分支呈“枯树枝样”或“蜘蛛网样”改变;病理学表现为肝窦淤血、扩张,肝细胞不同程度变性、坏死,中央静脉或小叶下静脉内皮水肿或纤维增生.经内科治疗18例(78.3%)好转,1例(4.3%)未治,2例(8.7%)无效,2例(8.7%)死亡.结论服用某些中药、化疗及免疫抑制剂治疗是主要诱因,确诊需要病理依据,根据病史、临床表现及特征性的影像学表现及病理结果可临床诊断,早期使用保肝、抗凝、改善微循环药物对改善预后有一定作用.
目的總結肝竇阻塞綜閤徵(hepatic sinusoidal obstruction syndrome,HSOS)的臨床特點,提高對該病的認識.方法迴顧性分析解放軍總醫院23例HSOS的臨床資料.結果23例中8例(34.7%)近期曾服用中藥(其中4例含有土三七),2例(8.7%)接受化療及免疫抑製劑治療,2例(8.7%)服用鎮痛藥(含非甾體類藥物),11例(47.9%)無明確誘因.臨床主要錶現為腹水(78.3%)、腹脹(73.9%)、肝大(21.7%)、肝區疼痛(26.1%)、黃疸(17.4%),有不同程度的肝功能受損.B超檢查見肝質地迴聲增粗、分佈不均,呈“斑片狀”,肝靜脈顯示不清或明顯變細,血流降低或消失,肝段下腔靜脈多錶現為受壓變細;增彊CT示肝髒呈“地圖狀”彊化不均勻;血管造影顯示肝靜脈遠耑小分支呈“枯樹枝樣”或“蜘蛛網樣”改變;病理學錶現為肝竇淤血、擴張,肝細胞不同程度變性、壞死,中央靜脈或小葉下靜脈內皮水腫或纖維增生.經內科治療18例(78.3%)好轉,1例(4.3%)未治,2例(8.7%)無效,2例(8.7%)死亡.結論服用某些中藥、化療及免疫抑製劑治療是主要誘因,確診需要病理依據,根據病史、臨床錶現及特徵性的影像學錶現及病理結果可臨床診斷,早期使用保肝、抗凝、改善微循環藥物對改善預後有一定作用.
목적총결간두조새종합정(hepatic sinusoidal obstruction syndrome,HSOS)적림상특점,제고대해병적인식.방법회고성분석해방군총의원23례HSOS적림상자료.결과23례중8례(34.7%)근기증복용중약(기중4례함유토삼칠),2례(8.7%)접수화료급면역억제제치료,2례(8.7%)복용진통약(함비치체류약물),11례(47.9%)무명학유인.림상주요표현위복수(78.3%)、복창(73.9%)、간대(21.7%)、간구동통(26.1%)、황달(17.4%),유불동정도적간공능수손.B초검사견간질지회성증조、분포불균,정“반편상”,간정맥현시불청혹명현변세,혈류강저혹소실,간단하강정맥다표현위수압변세;증강CT시간장정“지도상”강화불균균;혈관조영현시간정맥원단소분지정“고수지양”혹“지주망양”개변;병이학표현위간두어혈、확장,간세포불동정도변성、배사,중앙정맥혹소협하정맥내피수종혹섬유증생.경내과치료18례(78.3%)호전,1례(4.3%)미치,2례(8.7%)무효,2례(8.7%)사망.결론복용모사중약、화료급면역억제제치료시주요유인,학진수요병리의거,근거병사、림상표현급특정성적영상학표현급병리결과가림상진단,조기사용보간、항응、개선미순배약물대개선예후유일정작용.
Objective To improve the understanding of diagnosis and treatment of hepatic sinusoidal syndrome(HSOS) by analyzing its clinical features. Methods Clinical data about 23 HSOS patients admitted to Chinese PLA General Hospital were retrospectively analyzed. Results Of the 23 HSOS patients, 8(34.7%) were treated with Chinese medicines containing Gynura Rhizom, 2(8.7%) received chemotherapy and immunosuppressive therapy, 2(8.7%) were given analgesics including nonsteroidal anti-inflammatory agents, and 11(47.9%) had no clear predisposing cause. Their main clinical manifestations were ascites(78.3%), abdominal distension(73.9%), hepatomegaly(21.7%), abdominal pain at the right upper quadrant(26.1%) and jaundice(17.4%), with varying degrees of impaired liver function. Type-B ultrasonography(US) showed uneven distribution of enhanced echo in liver, unclear plaque or very fine hepatic vein,decreased or disappeared blood flow in portal vein,and flat posterohepatic vena cava. Enhanced CT scanning showed map-like uneven distribution of contrast agent in liver. Angiography revealed dry branch like or spider web-like changes in liver. Pathology demonstrated hepatic sinusoid congestion and dilatation, degeneration and necrosis of hepatic cells at different degrees, endothelial oedema or fibrosis of central vein or sublobular vein. Of the 23 patients after medical treatment, 18(78.3%) were improved, 1(4.3%) received no treatment, 2(8.7%) failed to treatment, and 3(8.7%) died. Conclusion Take administration of certain Chinese herbal medicine,chemotherapy and immunosuppressive therapy are the main predisposing cause of HSOS. Its diagnosis can be established according to its pathology, history, clinical manifestations and characteristic imaging. Early use of liver-protective, anticoagulant and microcirculation drugs can improve the prognosis of HSOS patients.
