肝吸虫病伴Budd-Chiari综合征1例MDT讨论  

MDT discussion of a case of clonorchiasis with Budd-Chiari syndrome

作　　者：李寅 游科[1] 王佳国 刘作金[1] LI Yin;YOU Ke;WANG Jiaguo;LIU Zuojin(Department of Hepatobiliary Surgery,The Second Afliated Hospital of Chongqing Medical University,Chongqing 400010 P.R.China)

机构地区：[1]重庆医科大学附属第二医院肝胆外科,重庆400010

出　　处：《中国普外基础与临床杂志》2022年第9期1174-1180,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的通过多学科协作团队(multidisciplinary team,MDT)模式讨论1例肝吸虫病伴BuddChiari综合征患者的治疗。方法对重庆医科大学附属第二医院于2021年8月收治的1例肝吸虫病伴BuddChiari综合征患者的MDT讨论及疾病诊治过程进行总结。结果该患者因“肝部分切除术后8年余,腹胀1年余”入院。入院前8年患者因右肝巨大占位行右三肝切除术+左肝管-空肠吻合术。术后病理学检查结果提示:多灶坏死伴肉芽肿反应,考虑寄生虫性感染。入院前1年患者开始出现腹水,经内科治疗疗效不佳。本次入院后行上腹部CT检查提示下腔静脉肝段狭窄、肝静脉显示不清及大量腹水。经MDT讨论后决定行直接性肝内门腔静脉分流术(direct intrahepatic portosystemic shunt,DIPS)联合经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA),出院后随访9个月血管支架通畅,未见腹水再发。结论DIPS联合PTA能够明显改善继发于肝吸虫的Budd-Chiari综合征患者的临床症状,通过MDT模式讨论可提高治疗的有效性,获得更好的预后。Objective To explore the treatment of a case of clonorchiasis with Budd-Chiari syndrome through multidisciplinary team(MDT)discussion.Methods A case of clonorchiasis with Budd-Chiari syndrome was treated in the Second Affiliated Hospital of Chongqing Medical University in August 2021.We summarized the discussion of MDT and the process of diagnosis and treatment.Results The patient was admitted because of“more than 8 years after partial hepatectomy and more than 1 year of abdominal distension”.Eight years before admission,the patient underwent right hepatic trisegmentectomy and left hepaticojejunostomy due to a huge space occupying right liver.Postoperative pathological examination revealed multifocal necrosis with granulomatous reaction,and parasitic infection was considered.One year before admission,the patient began to have ascites,and the medical treatment was ineffective.The CT examination of the upper abdomen after admission showed hepatic segmental stenosis of the inferior vena cava,unclear display of the hepatic veins and a large amount of ascites.After MDT discussion,this patient underwent direct intrahepatic portosystemic shunt(DIPS)and percutaneous transluminal angioplasty(PTA),and the stent was unobstructed in the 9-month follow-up after discharge,and no recurrence of ascites was found.Conclusions DIPS combined with PTA can significantly improve the clinical symptoms of clonorchiasis with BuddChiari syndrome.Discussion through MDT mode can improve the effectiveness of treatment and obtain better prognosis.

关 键 词：多学科协作团队 肝吸虫病 BUDD-CHIARI综合征 直接性肝内门腔静脉分流术 经皮腔内血管成形术 

分 类 号：R657.3[医药卫生—外科学] R532.2[医药卫生—临床医学]