肝门静脉积气31例临床特征分析  

Clinical features of hepatic portal venous gas: an analysis of 31 cases

作　　者：周艳华[1] 赵海英[1] 陈奕均 马丹 宗晔[1] Zhou Yanhua;Zhao Haiying;Chen Yijun;Ma Dan;Zong Ye(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Disease,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,国家消化系统疾病临床医学研究中心,北京100050

出　　处：《中华全科医师杂志》2024年第5期475-479,共5页Chinese Journal of General Practitioners

摘　　要：目的总结肝门静脉积气(HPVG)患者的临床特点。方法该研究为回顾性研究。回顾分析2015年1月至2023年12月于首都医科大学附属北京友谊医院经腹部CT诊断的31例HPVG患者的人口学资料、症状、合并症、病因、实验室检查结果、腹部CT检查结果、治疗与转归。结果31例患者男女比例为2.1∶1,年龄(72.7±12.5)岁。常见症状为腹痛[90.3%(28/31)]、呕吐[41.9%(13/31)]和感染性休克[32.3%(10/31)]。15例(48.4%)患者合并冠状动脉粥样硬化性心脏病,18例(58.1%)合并2型糖尿病,22例(71.0%)合并高血压病。72.4%(21/29)患者外周血白细胞计数水平升高。所有患者腹部CT检查结果均提示肝门静脉系统可见透亮积气影。病因为肠缺血/坏死17例(54.8%)、肠梗阻7例(22.6%)、可疑肠穿孔3例(9.7%)、肠道炎症2例(6.5%)、吻合口瘘1例(3.2%)、颈静脉肝内门腔静脉分流术后1例(3.2%)。7例(22.6%)患者行急诊手术联合静脉抗菌药物抗感染治疗;19例(61.3%)患者未行手术治疗,其中18例采用了以静脉抗菌药物抗感染为主的保守治疗,1例未给予特殊治疗;另有5例(16.1%)转外院治疗。26例在我院治疗的患者中,16例(61.5%)治疗有效,10例(38.5%)于发病3 h~50 d死亡。其中手术治疗7例患者中6例康复,1例死亡;19例保守治疗患者中10例康复,9例死亡。共13例患者于发病0~30 d复查腹部CT,12例门静脉积气消失,中位消失时间为3.5 d;1例门静脉积气减少。结论HPVG病因复杂,部分病例进展快,预后欠佳。腹部CT是HPVG的推荐诊断方法。Objective To analyze the clinical characteristics of patients with hepatic portal venous gas(HPVG).Methods Clinical data of 31 patients with HPVG diagnosed by abdominal CT in Beijing Friendship Hospital of Capital Medical University from January 2015 to December 2023 were retrospectively analyzed,including demographic characteristics,clinical symptoms,comorbidities,laboratory tests,abdominal CT,treatments and outcomes.Results The male to female ratio was 2.1∶1,and the mean age was(72.7±12.5)years.The common symptoms were abdominal pain(28/31,90.3%),vomiting(13/31,41.9%)and septic shock(10/31,32.3%).Comorbidities were coronary atherosclerotic heart disease(15/31,48.4%),type 2 diabetes mellitus(18/31,58.1%),and hypertension(22/31,71.0%).Complete blood counts showed leukocytosis in 72.4%patients(21/29).Abdominal CT revealed gas in the portal venous system in all patients.The causes of HPVG were intestinal ischemia/necrosis in 17 cases(54.8%),intestinal obstruction in 7 cases(22.6%),suspected intestinal perforation in 3 cases(9.7%),enteritis in 2 cases(6.5%),anastomotic fistula in 1 case(3.2%),and post transjugular intrahepatic portosystemic shunt in 1 case(3.2%).Seven patients were treated with emergency surgery combined with intravenous antibiotics;19 patients did not receive surgery,of whom 18 patients chose intravenous antibiotics-based conservative treatment,and 1 patient received no special treatment;another 5 cases were transferred to other hospitals.Among 26 patients treated in our hospital,16(61.5%)recovered,and 10(38.5%)died within 3 h-50 d of onset.In the surgical group,6 cases recovered and 1 case died;in the conservative group,10 cases recovered and 9 cases died.Thirteen patients were reexamined by abdominal CT at 0-30 d after onset,showing that portal venous gas disappeared in 12 cases,with the median time of 3.5 d;and portal venous gas reduced in 1 case.Conclusions HPVG has complex potential causes,it progresses rapidly in some cases and the prognosis is poor.Abdominal CT is recommended for diagnosi

关 键 词：腹痛 肝门静脉积气 腹部CT 外科手术 

分 类 号：R575[医药卫生—消化系统]