药物性肝损伤合并门静脉血栓形成9例研究

Drug-induced liver injury in patients with portal venous thrombosis 9 cases

目的探讨药物性肝损伤(DILI)合并门静脉血栓形成(PVT)的治疗方案和效果。方法回顾性分析2014年3月至2016年3月河北医科大学第二医院血管外科收治的9例DILI合并PVT患者的临床资料,其中4例患者接受保守治疗;2例患者接受经肠系膜上动脉(SMA)置管溶栓治疗;2例患者出现腹膜炎体征行肠坏死切除术;1例患者出现胃肠出血、顽固性腹水的症状,接受经颈静脉肝内门体分流术(TIPS)治疗。结果 4例保守治疗,其中2例病情好转,2例死亡(1例发生多器官功能衰竭,1例出现电解质紊乱、感染性休克等症状);2例经SMA导管溶栓治疗,均在症状缓解后出院;2例行肠坏死切除术+血栓切除术,其中1例症状缓解,1例出现肠瘘、严重感染,经抢救无效死亡;1例行TIPS术,未出现重度肝性脑病。结论对于急性PVT患者,建议行导管溶栓治疗,在出现肠坏死时行急诊手术治疗,在出现门静脉高压继发顽固性腹水和胃肠出血时行TIPS治疗,效果均比较满意。治疗的关键在于早期诊断并且根据患者的症状选择合适的治疗方案。

Objective To explore the treatment methods and the efficacy of patients with drug-induced liver injury（DILI） combined portal venous thrombosis（PVT）. Methods From March 2014 to March 2016, the clinical diagnosis and treatment data of 9 DILI patients with PVT were analyzed retrospectively in the Second Hospital of Hebei Medical University. 4 patients accepted conservative treatment, 2 patients accepted superior mesenteric artery catheter thrombolysis treatment, 2 patients with peritonitis signs accepted intestinal necrosis resection, 1 patient with symptoms of digestive tract hemorrhage and refractory ascites, received transjugular intrahepatic portosystemic shunt（TIPS）. Results 4 patients accepted conventional therapy, and there were two improvement and two deaths（1 patient was because of multiple organ failure, 1 patient was due to electrolyte disturbance and septic shock）. 2 patients accepted superior mesenteric artery catheter thrombolysis therapy and discharged after symptom relief. 2 patients accepted intestinal necrosis resection ＋ thrombectomy, and there were one symptom relief and one death after rescue finally because of intestinal leakage and severe infection. 1 patient accepted TIPS without severe hepatic encephalopathy. Conclusions Patient with acute PVT is suggested to receive catheter thrombolysis therapy. It needs emergency operation when there is a intestinal necrosis and needs TIPS therapy when there is a portal hypertension secondary to the refractory ascites and gastrointestinal bleeding, which can obtain satisfactory effect. Early diagnosis and choosing appropriate treatment according to symptoms are the key.