摘要
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。
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.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2012年第9期620-624,共5页
Chinese Journal of Digestion
关键词
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
Hepatic veno-occlusive disease
Alkaloids
Drugs, Chinese herbal
Biopsy, needle
Anticoagulants
