肝小静脉闭塞病20例临床分析  

Clinical Analysis of 20 Cases of Hepatic Veno Occlusive Disease

作　　者：龙春梅[1] 郑中伟[1] 陈定贵[1] 

机构地区：[1]常州市第三人民医院消化内科,江苏常州213000

出　　处：《系统医学》2017年第12期32-34,共3页Systems Medicine

摘　　要：目的探讨肝小静脉闭塞病(HVOD)的临床特点与诊治经验。方法回顾性分析该院2006年1月—2016年12月间收治的20例HVOD患者的病因、临床表现、临床检查、病理特征及治疗与转归情况。结果 15例(75%)HVOD由服用"土三七"引起。临床表现以腹水、肝大、肝区疼痛、黄疸及体质量增加为其主要特征。实验室检查显示,肝功能损害、血清CA125升高。超声示肝肿大,肝静脉变细,血流速度减慢或无血流信号。CT示肝外形饱满,平扫密度欠均匀,肝实质密度降低;增强扫描示肝实质不均匀强化,呈"地图样"改变。病理提示中央静脉周围肝窦高度扩张、淤血,汇管区肝小静脉内皮肿胀、管壁增厚。经治疗后8例(40%)好转,其余均因病情加重自动出院或死亡。结论土三七是导致HVOD的一个重要原因,可根据病史、临床表现和特征性影像学表现来确诊,但不典型病例仍需行肝组织穿刺检查。HVOD病死率较高,早期诊断和及时治疗尤为重要,采用抗凝和活血化瘀对改善预后有一定作用。Objective This paper tries to investigate the clinical characteristics and treatment of hepatic veno occlusive disease（HVOD）. Methods The etiology, clinical manifestations, clinical findings, pathological features, treatment and prognosis of 20 patients with HVOD in this hospital from January 2006 to December 2016 were analyzed retrospectively. Results 15 cases（75%） of HVOD were caused by taking herb of chrysanthemum-like groundsel. The main clinical features were ascites, hepatomegaly, hepatalgia, jaundice and weight gain. Laboratory tests showed that impaired liver function and elevated serum CA125 levels occurred. Ultrasound showed hepatomegaly, hepatic vein became thinner, blood flow slowed or no blood flow signal. CT showed the liver shape was plump, the scan density was not uniform, and the density of liver parenchyma decreased. The enhanced scan showed inhomogeneous enhancement of liver parenchyma and a map-like change. Pathological findings showed that the hepatic sinusoid was dilated and congested around the central vein, and the endothelium of the small hepatic vein of the portal area was swollen and the wall of the tube was thickened. After treatment, 8 cases（40%） improved, and the rest were discharged or died due to exacerbation of the disease. Conclusion Herb of chrysanthemum-like groundsel is an important cause of HVOD. It can be diagnosed according to medical history, clinical manifestations and characteristic imaging findings. However, liver biopsy is still needed in atypical cases. The fatality rate of HVOD is high. Early diagnosis and timely treatment are especially important. Anticoagulant therapy and activating blood circulation to dissipate blood stasis can improve prognosis.

关 键 词：肝小静脉闭塞病 土三七 中草药 诊断 

分 类 号：R575[医药卫生—消化系统]