布加综合征并发肝细胞癌破裂出血一例  

A case of Budd-Chiari syndrome complicated with hepatocellular carcinoma rupture and hemorrhage

作　　者：李娇娇 孙蔚[1] LI Jiao-jiao;SUN Wei(Department of Infections Diseases,The First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院感染科,江苏苏州215000

出　　处：《医师在线》2024年第9期75-78,共4页Journal of Doctors Online

基　　金：2020年度天晴肝病研究基金科研课题(TQGB20210134)。

摘　　要：目的通过病例报告及相关文献分析,提高对布加综合征并发肝细胞癌破裂出血的认识和诊治水平。方法回顾性分析2022年1月我院收治的一例以腹痛为主要表现患者的临床特点、诊治过程及预后,并进行总结。结果患者因上腹部疼痛入院,腹部CT提示肝癌破裂出血;肝硬化。乙型肝炎与丙型肝炎病毒标志物、抗核抗体谱及自身免疫性肝病组套、铜蓝蛋白均为阴性,进一步完善腹部增强MRI,考虑患者原发病为布加综合征。为明确诊断行下腔静脉造影术,最终诊断为布加综合征并发肝细胞癌破裂出血。结论本例患者无肝炎病史,由于下腔静脉狭窄导致淤血性肝硬化,进而发展为肝细胞癌,因临床表现复杂多变而无特异性,诊治过程中应注意询问患者既往史,注重影像学资料,从而提高诊疗水平。Objective To improve the understanding,diagnosis and treatment of Budd-Chiari syndrome complicated with hepatocellular carcinoma rupture and hemorrhage through case reports and related literature analysis.Methods The clinical characteristics,diagnosis and treatment process,and prognosis of a patient with abdominal pain as the main manifestation admitted to our hospital in January 2022 were retrospectively analyzed and summarized.Results The patient was admitted to the hospital due to epigastric pain.Abdominal CT showed ruptur and hemorrhage of hepatocellular carcinoma and cirrhosis.Hepatitis B and C viral markers,antinuclear antibody,autoimmune liver disease group and ceruloplasmin were negative.Further abdominal enhanced MRI was performed.The patient was considered to have Budd-Chiari syndrome as the primary disease.The diagnosis of Budd-Chiari syndrome complicated with hepatocellular carcinoma rupture and hemorrhage was confirmed by inferior vena cava angiography.Conclusion In this case,the patient had no history of hepatitis.Due to the stenosis of the inferior vena cava,the patient developed congestive cirrhosis,which in turn developed into hepatocellular carcinoma.Due to the complex and changeable clinical manifestations,there was no specificity.In the process of diagnosis and treatment,attention should be paid to the patient's past history and imaging data,so as to improve the level of diagnosis and treatment.

关 键 词：布加综合征 肝细胞癌破裂出血 淤血性肝硬化 

分 类 号：R735.7[医药卫生—肿瘤] R575[医药卫生—临床医学]