谈谈肝小静脉闭塞病的彩超表现
【摘要】 目的. 研究肝小静脉闭塞病的临床和彩超表现，探讨其彩超特征。方法 回顾性分析因外伤服用“土三七”后,经病理和临床诊断的肝小静脉闭塞病16例的超声资料。结果 16例超声检查均显示肝肿大、腹水，肝区实质回声呈“豹纹状”、“斑片状”低回声区。肝静脉显示不清或未见显示15例，表现细小1例。16例下腔静脉肝段均受压变细、变窄，无远端扩张。4例血管造影显示肝静脉及下腔静脉无栓塞。16例门静脉主干内径均正常，但血流速缓慢。肝穿刺活检6例病理诊断肝小静脉闭塞病。结论 彩超对肝小静脉闭塞病诊断有一定价值。【关键词】 菊三七 肝小静脉闭塞病 彩超
【Abstract】 Objective To evaluate the clinical and sonographic characteristics of hepatic veno-occlusive disease. Methods Sixteen patients with hepatic veno-occlusive disease cases (meso-age 57 years, range 42～74 years) diagnosed by pathobiology or clinical manifestation were recruited into study group. All patients had history of taking in the traditional Chinese ical herb “gynura segetum” due to trauma. Enhanced CT scanning and ultrasonographic examinations were performed on all cases. Angiography was performed on four cases, and hepatic tissue biopsy guided by ultrasound was performed on six cases. Results All cases revealed ascites, hepatomegaly, and panther- stripe or patching low echogenic area of liver on two-dimensional ultrasound imaging. Only one case showed small hepatic vein, and hepatic veins of the others were indistinct or not showed. Hepatic segments of inferior vena were narrow, flat. Four cases showed unobstructed blood flow in hepatic vein and inferior vena using angiography. The diameters of main portal veins were normal, but the velocities of flow blood were slowly in all cases. Six cases were diagnosed by pathobiology. Conclusions Ultrasonography plays very important role in confirming diagnosis for hepatic veno-occlusive disease.
【Key words】 Gynura segetum Hepatic veno-occlusive disease Ultrasound
肝小静脉闭塞病(veno occlusive disense,VOD)非常罕见［１～３］。本文收集外伤后服用“土三七”（gynura segetum，又名“菊三七”［４］）引起肝小静脉闭塞病16例，就其病史和彩超表现作一分析，旨在探讨肝小静脉闭塞病的超声特征性表现。
1 临床资料
1.1 一般资料 1996年12月至2006年12月，本院收治VOD 16例，其中男7例，女9例，年龄42～74岁（中位年龄57岁）。16例患者外伤或骨折后均有服用“土三七”史。新鲜“土三七”煎服，每天30～70g（平均50g）,总剂量300～700g（平均500g）,服用后15～45d(平均28d)，出现上腹部胀痛不适和肝功能损害、腹水。体检：肝肿大，腹水，腹壁浅静脉无曲张。实验室检查：表面抗原阳性1例，总胆红素升高15例，直接胆红素升高1例，丙氨酸转氨酶升高13例， 碱性磷酸酶升高11例，谷氨酰转肽酶、天冬氨酸转氨酶升高14例，白蛋白下降6例，白蛋白/球蛋白比例下降13例，凝血酶原时间延长4s以上10例，延长2s以上6例。其中6例经超声引导下穿刺病理活检，4例经DSA检查。诊断为VOD后立即停用菊三七，经过低分子肝素、阿司匹林及护肝利尿等针对性治疗，经过随访(最短6个月，最长6年)，一般情况良好，肝脏肿大消退，无腹水，肝功能全部恢复正常。
1.2 VOD诊断标准 参照文献［５，６］：（1）其他原因无法解释的胆红素增高（≥34.2μmol/L）；（2）疼痛性肝肿大、腹水、不明原因的体重增加(≥2%以上)3项中符合2项；（3）肝穿剌活检病理检查证实。