門靜脈海綿樣變65例臨床分析
發(fā)布時間：2018-08-02 08:40
【摘要】：目的:探討門靜脈海綿樣變的病因、臨床特點、診斷方法及治療。方法:采用回顧性分析方法分析蘭州大學第一醫(yī)院從2007年1月至2016年11月住院確診的65例門靜脈海綿樣變患者,對納入研究的患者收集其一般資料、實驗室指標、影像學檢查、治療方案及預后。運用統(tǒng)計學方法分析門靜脈海綿樣變的主要臨床特點、病因、不同病因患者的臨床特點、治療及預后因素等。結果:1.本研究65例門靜脈海綿樣變患者年齡在3~81歲之間,平均年齡48.39±15.53歲,以40-59歲為高發(fā)年齡段,占56.93%,男性發(fā)病率高(72.31%)。2.按病因分組:18例(27.69%)患者病因多不明確,考慮原發(fā)性可能大。繼發(fā)性門靜脈海綿樣變發(fā)病率較高(72.31%),以血栓(39%)和癌栓(15%)為主。通過比較不同病因組患者在性別、年齡的均數(shù)及各年齡組之間均存在顯著差異(P0.05),說明原發(fā)性門靜脈海綿樣變以青年女性為主,繼發(fā)性門靜脈海綿樣變以中年男性為主。3.本組多見癥狀有腹痛(55.38%)、腹脹(52.31%)、上消化道出血如嘔血、黑便(41.54%)。通過比較不同病因組患者上消化道出血的發(fā)生率存在顯著差異(P0.05),說明上消化道出血在繼發(fā)性門靜脈海綿樣變中更常見。本組患者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型為主。通過比較不同臨床類型患者在性別、年齡及病因方面有統(tǒng)計學差異(P0.05):Ⅲ型以中年男性為主,Ⅳ型以青年女性為主;原發(fā)性門靜脈海綿樣變以Ⅰ型與Ⅳ型為主,繼發(fā)性門靜脈海綿樣變以Ⅱ型與Ⅲ型為主。4.實驗室檢查:WBC減少者19例(29.23%)、Hb減少者21例(32.31%)、PLT減少者32例(49.23%),三系均減少者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延長者35例(53.85%)、D-二聚體定量增高者87.5%(7/8)、AFP增高9例(13.85%)。通過比較D-二聚體(升高)、AFP(增高)在不同病因中的發(fā)生率有顯著差異(P0.05):D-二聚體(升高)、AFP(增高)在繼發(fā)性門靜脈海綿樣變中所占比例高。所有患者均按Child-pugh分級標準評估肝功能,肝功能A級31例(47.69%),B級28例(43.08%),C級6例(9.23%),以A級及B級為主。通過比較不同肝功能分級患者在性別、各年齡組、病因、臨床類型方面無統(tǒng)計學差異(P0.05)。5.診斷方法:所有患者經(jīng)彩色多普勒超聲和(或)上腹部增強CT、MRI、DSA檢查診斷,各種影像學檢查之間的診斷符合率幾乎達100%。本組病例門靜脈系統(tǒng)栓塞35例(53.85%),25例(71.43%)為血栓,10例(28.57%)為門靜脈癌栓,通過比較不同類型栓子在栓塞部位無統(tǒng)計學差異(P0.05)。本組病例影像學還包括食管胃底靜脈曲張、肝硬化、AHC等,通過比較不同病因患者食管胃底靜脈曲張、肝硬化、AHC、腹水、腸淤血的發(fā)生率有統(tǒng)計學差異(P0.05):AHC在原發(fā)性門靜脈海綿樣變中更常見,食管胃底靜脈曲張、肝硬化、腹水、腸淤血在繼發(fā)性門靜脈海綿樣變中更常見。6.治療:31例(47.69%)患者采取內科保守治療,效果不佳,多因反復上消化道出血、血栓復發(fā)在短期內多次入院。34例(52.31%)患者行手術治療,預后良好,包括內鏡、介入或外科手術,本組患者TIPS手術成功率為50%(5/10)。結論:我院近5年門靜脈海綿樣變患者以男性發(fā)病率較高。按病因分為原發(fā)性和繼發(fā)性兩類,原發(fā)性多見于青年女性,繼發(fā)性多見于中年男性。繼發(fā)性門靜脈海綿樣變多見,病因以血栓和癌栓為主。臨床表現(xiàn)以肝前型門靜脈高壓癥為主,臨床分型以Ⅱ、Ⅲ為主。實驗室檢查無特異性指標,肝功能分級以A、B為主。合理利用多種影像診斷方法能對門靜脈海綿樣變做出正確診斷,彩色多普勒超聲是門靜脈海綿樣變的首選診斷方法。內科保守治療效果不佳,預后差,易復發(fā)。治療應根據(jù)患者的具體情況,采取藥物、內鏡、介入及外科手術等綜合性治療措施,其中TIPS是治療門靜脈海綿樣變可行、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.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575
本文編號：2158852
[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.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575
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