肝门静脉积气诊断与治疗的临床分析  

Clinical analysis of the diagnosis and treatment of hepatic portal venous gas

作　　者：周擎云 吕昕亮[1] 朱锦德[1] 谭炜[1] 张坤[1] Zhou Qingyun;Lyu Xinliang;Zhu Jinde;Tan Wei;Zhang Kun(Department of Hepatobiliary and Pancreatic Surgery,Lishui Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院肝胆胰外科,丽水323000

出　　处：《国际外科学杂志》2024年第10期716-720,F0004,共6页International Journal of Surgery

基　　金：丽水市科技计划项目(2022ZDYF08)。

摘　　要：目的探讨肝门静脉积气(HPVG)的临床表现、诊疗方法及预后。方法采用回顾性病例分析的方法,收集2017年1月—2024年7月丽水市中心医院收治的7例HPVG患者的病例资料,其中男性5例,女性2例;年龄46~90岁,平均年龄为69岁;6例患者以腹痛为首发症状,2例患者就诊时出现感染性休克。分析患者的始发症状、原发疾病、合并症、实验室检查结果、影像学检查、治疗方案及预后等。预后随访采用电话随访,随访内容为患者是否出现HPVG复发及术后并发症,截止日期为2024年7月31日。结果7例患者均出现白细胞、C反应蛋白(CRP)升高,4例患者凝血酶原时间延长;4例患者pH值、碱剩余减低,5例患者乳酸升高,2例患者谷丙转氨酶升高,3例患者总胆红素升高;3例患者血培养阳性;7例患者腹部增强CT均提示门静脉及其分支中出现透亮气体影,其中4例患者局限于左肝,3例患者左、右肝均有分布;4例患者原发疾病为肠梗阻、肠坏死,1例患者为肠穿孔、肠坏死,1例患者为炎症性肠病,1例患者为急性胰腺炎;5例患者合并高血压或糖尿病等疾病;2例患者接受手术治疗,手术距离确诊的平均时间为6.8 h,均治愈;5例患者接受保守治疗,其中2例治愈,3例死亡,死亡距发病平均时间为21.2 h。结论腹部增强CT应作为诊断HPVG的首选方法。HPVG的治疗应充分评估原发病及其严重程度,存在肠坏死表现的患者应尽早进行剖腹手术,术中应联合行肠造瘘术。临床医师应加强对HPVG的认识,以改善患者预后。ObjectiveTo explore the clinical manifestations,diagnosis and treatment methods,and prognosis of hepatic portal venous gas(HPVG).MethodsRetrospective case analysis was used in the case data of 7 patients with HPVG,who were treated in Lishui Central Hospital from January 2017 to July 2024,including 5 males and 2 females.Age ranged from 46 to 90 years,with an average age of 69 years.Abdominal pain was the first manifestation in 6 cases,and septic shock occurred in 2 cases.The initial symptoms,primary diseases,comorbidities,laboratory results,imaging examinations,treatment plans,and prognosis were analyzed.Prognostic follow-up was conducted by telephone,with the focus on whether the patient had experienced HPVG recurrence and postoperative complications.The deadline for follow-up was July 31,2024.ResultsAll patients had elevated white blood cells and C-reactive protein(CRP),and prothrombin time was prolonged in 4 patients.pH and base excess decreased in 4 cases,and lactic acid increased in 5 cases.Alanine aminotransferase increased in 2 cases,and total bilirubin increased in 3 cases.Blood culture was positive in 3 cases.Contrast-enhanced abdominal CT showed clear gas shadows in the portal vein and its branches in all 7 cases,which were confined to the left liver in 4 cases and distributed in both sides of the liver in 3 cases.The primary diseases were intestinal obstruction and necrosis in 4 cases,intestinal perforation and necrosis in 1 case,inflammatory bowel disease in 1 case,and acute pancreatitis in 1 case.Five patients were complicated with hypertension,diabetes and other diseases.Two patients received surgical treatment,and the average time from surgery to diagnosis was 6.8 h.Five cases received conservative treatment,2 cases were cured and 3 cases died,with an average time from onset to death of 21.2 h.ConclusionsContrast-enhanced abdominal CT should be the preferred method for the diagnosis of HPVG.The primary disease and its severity should be fully evaluated in the treatment of HPVG.Patients with intestin

关 键 词：门静脉 诊断 治疗结果 肝门静脉积气 肠坏死 

分 类 号：R575[医药卫生—消化系统]