门静脉海绵样变65例临床分析

发布时间：2018-08-02 08:40

【摘要】：目的:探讨门静脉海绵样变的病因、临床特点、诊断方法及治疗。方法:采用回顾性分析方法分析兰州大学第一医院从2007年1月至2016年11月住院确诊的65例门静脉海绵样变患者,对纳入研究的患者收集其一般资料、实验室指标、影像学检查、治疗方案及预后。运用统计学方法分析门静脉海绵样变的主要临床特点、病因、不同病因患者的临床特点、治疗及预后因素等。结果:1.本研究65例门静脉海绵样变患者年龄在3~81岁之间,平均年龄48.39±15.53岁,以40-59岁为高发年龄段,占56.93%,男性发病率高(72.31%)。2.按病因分组:18例(27.69%)患者病因多不明确,考虑原发性可能大。继发性门静脉海绵样变发病率较高(72.31%),以血栓(39%)和癌栓(15%)为主。通过比较不同病因组患者在性别、年龄的均数及各年龄组之间均存在显著差异(P0.05),说明原发性门静脉海绵样变以青年女性为主,继发性门静脉海绵样变以中年男性为主。3.本组多见症状有腹痛(55.38%)、腹胀(52.31%)、上消化道出血如呕血、黑便(41.54%)。通过比较不同病因组患者上消化道出血的发生率存在显著差异(P0.05),说明上消化道出血在继发性门静脉海绵样变中更常见。本组患者Ⅰ型9例(9.23%),Ⅱ型37例(56.92%),Ⅲ型15例(23.08%),Ⅳ型4例(6.15%),以Ⅱ、Ⅲ型为主。通过比较不同临床类型患者在性别、年龄及病因方面有统计学差异(P0.05):Ⅲ型以中年男性为主,Ⅳ型以青年女性为主;原发性门静脉海绵样变以Ⅰ型与Ⅳ型为主,继发性门静脉海绵样变以Ⅱ型与Ⅲ型为主。4.实验室检查:WBC减少者19例(29.23%)、Hb减少者21例(32.31%)、PLT减少者32例(49.23%),三系均减少者16例(24.62%);AST增高者25例(38.46%)、ALT增高者18例(27.69%)、ALP增高者36例(55.38%)、PT延长者35例(53.85%)、D-二聚体定量增高者87.5%(7/8)、AFP增高9例(13.85%)。通过比较D-二聚体(升高)、AFP(增高)在不同病因中的发生率有显著差异(P0.05):D-二聚体(升高)、AFP(增高)在继发性门静脉海绵样变中所占比例高。所有患者均按Child-pugh分级标准评估肝功能,肝功能A级31例(47.69%),B级28例(43.08%),C级6例(9.23%),以A级及B级为主。通过比较不同肝功能分级患者在性别、各年龄组、病因、临床类型方面无统计学差异(P0.05)。5.诊断方法:所有患者经彩色多普勒超声和(或)上腹部增强CT、MRI、DSA检查诊断,各种影像学检查之间的诊断符合率几乎达100%。本组病例门静脉系统栓塞35例(53.85%),25例(71.43%)为血栓,10例(28.57%)为门静脉癌栓,通过比较不同类型栓子在栓塞部位无统计学差异(P0.05)。本组病例影像学还包括食管胃底静脉曲张、肝硬化、AHC等,通过比较不同病因患者食管胃底静脉曲张、肝硬化、AHC、腹水、肠淤血的发生率有统计学差异(P0.05):AHC在原发性门静脉海绵样变中更常见,食管胃底静脉曲张、肝硬化、腹水、肠淤血在继发性门静脉海绵样变中更常见。6.治疗:31例(47.69%)患者采取内科保守治疗,效果不佳,多因反复上消化道出血、血栓复发在短期内多次入院。34例(52.31%)患者行手术治疗,预后良好,包括内镜、介入或外科手术,本组患者TIPS手术成功率为50%(5/10)。结论:我院近5年门静脉海绵样变患者以男性发病率较高。按病因分为原发性和继发性两类,原发性多见于青年女性,继发性多见于中年男性。继发性门静脉海绵样变多见,病因以血栓和癌栓为主。临床表现以肝前型门静脉高压症为主,临床分型以Ⅱ、Ⅲ为主。实验室检查无特异性指标,肝功能分级以A、B为主。合理利用多种影像诊断方法能对门静脉海绵样变做出正确诊断,彩色多普勒超声是门静脉海绵样变的首选诊断方法。内科保守治疗效果不佳,预后差,易复发。治疗应根据患者的具体情况,采取药物、内镜、介入及外科手术等综合性治疗措施,其中TIPS是治疗门静脉海绵样变可行、安全、有效的方法。
[Abstract]:Objective: To investigate the etiology, clinical features, diagnostic methods and treatment of portal vein cavernous change. Methods: retrospective analysis was used to analyze 65 cases of cavernous changes in the portal vein diagnosed in First Hospital Affiliated to Lanzhou University from January 2007 to November 2016, and collect the general data, laboratory indexes and imaging examinations for the patients who were included in the study. The main clinical characteristics, etiology, clinical characteristics, treatment and prognostic factors of patients with different pathogeny were analyzed by statistical methods. Results: 1. the age of 65 patients with cavernous change of portal vein was between the age of 3~81 years, the average age was 48.39 + 15.53 years, and the age group was 40-59 years old, accounting for 56.93%. The high incidence of male (72.31%).2. was grouped according to the etiological factor: 18 cases (27.69%) were not clear in etiology, and the primary possibility was large. The secondary portal vein cavernous change incidence was higher (72.31%), thrombus (39%) and cancer thrombus (15%) were dominant. There were significant differences between age groups and age groups by comparing the patients with different etiological groups (P 0.05) the primary cavernous changes in the portal vein were predominantly young women, and secondary portal cavernous change in the middle aged male.3. group had abdominal pain (55.38%), abdominal distention (52.31%), hemorrhage in upper digestive tract such as hematemesis, and black stool (41.54%). There were significant differences in the incidence of upper gastrointestinal bleeding in different etiological groups (P0.05 It showed that hemorrhage in the upper gastrointestinal tract was more common in secondary portal cavernous change. 9 cases (9.23%), 37 cases (56.92%), 15 (23.08%), 4 (6.15%), type II and type III were dominant in this group. There were statistically significant differences in sex, age and etiological factors in different clinical types (P0.05): type III in middle age men. The primary and IV type was dominated by young women; primary portal vein cavernous changes were mainly type I and type IV, secondary portal vein cavernous changes were examined mainly by type II and type III.4. laboratory: 19 cases (29.23%) with WBC reduction, 21 (32.31%) in Hb reduction, 32 (49.23%) in PLT reduction, 16 in three (24.62%), 25 in AST (38.46%), ALT The increase was 18 (27.69%), ALP increased in 36 cases (55.38%), PT prolonged 35 cases (53.85%), D- two polymer was 87.5% (7/8), AFP increased in 9 cases (13.85%). The incidence of AFP (increase) in different etiology was significantly different (P0.05): D- two polymer (elevated), AFP (increase) in secondary portal cavernous change. The proportion of the patients was high. All patients were evaluated for liver function according to the Child-pugh classification standard, 31 cases (47.69%), 28 cases (43.08%) of grade B, 6 cases of grade C (9.23%), class A and B grade. There was no statistical difference (P0.05).5. diagnosis in all age groups, etiological factors and clinical types by comparing different liver function classification patients (P0.05).5. diagnosis method: all patients received color Color Doppler ultrasound and / or upper abdomen enhanced CT, MRI, DSA examination diagnosis, the diagnostic coincidence rate between various imaging examinations was almost 35 cases (53.85%), 25 cases (71.43%) were thrombus, 10 cases (28.57%) were portal vein tumor thrombus, and there was no statistical difference (P0.05) by comparing different types of embolus at the embolic site. The incidence of esophageal and gastric varices, cirrhosis, AHC and so on. The incidence of esophageal and gastric fundus varices, cirrhosis, AHC, ascites, and intestinal congestion were statistically different (P0.05): AHC was more common in primary portal cavernous change, esophagogastric varices, cirrhosis, ascites, and intestinal congestion. .6. treatment was more common in the cavernous change of the portal vein: 31 cases (47.69%) were treated with conservative treatment, and the results were not good. Many patients were repeatedly admitted to the digestive tract bleeding. The recurrence of thrombus was performed in.34 cases (52.31%) many times in the short term. The prognosis was good, including endoscopy, intervention or surgery. The successful rate of TIPS operation in this group was 50% (5/10 Conclusion: in the last 5 years, the incidence of male cavernous change in the portal vein was higher in our hospital. The primary and secondary two types were divided according to the cause of the disease. The primary disease was mostly seen in young women and secondary in middle-aged men. Secondary portal vein cavernous change was common, the cause was thrombus and tumor thrombus. The clinical manifestation was anterior hepatic portal hypertension. There is no specific index in the bed type. There is no specific index in the laboratory. The classification of liver function is A and B. Rational use of various imaging diagnosis methods can make a correct diagnosis of portal vein cavernous change. Color Doppler ultrasound is the first choice for diagnosis of portal vein cavernous change. According to the specific condition of the patient, comprehensive treatment measures such as medicine, endoscopy, intervention and surgery are adopted, in which TIPS is a feasible, safe and effective method for the treatment of cavernous changes in the portal vein.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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