土三七致肝窦阻塞综合征的临床及CT特征研究

Clinical linical and CT features of Tusanqi-induced hepatic sinusoidal obstruction syndrome

目的探讨土三七致肝窦阻塞综合征(PA-HSOS)患者的临床、肝损伤及CT特征,为PA-HSOS的早期诊断和治疗奠定基础。方法选取31例PA-HSOS患者的临床资料和CT图像、与同期收治的46例肝静脉型布加综合征(HV-BCS)患者的资料行对比分析,观察PA-HSOS患者具有特征性的临床表现及CT征象。结果PA-HSOS与HV-BCS患者相比,超急性/急性期多见,年龄较大,肝损伤程度更高。第二肝门处“爪形”强化、肝静脉和下腔静脉肝段变细但通畅、肝尾状叶体积不大、肝内侧枝循环少见、门静脉周围晕征为PA-HSOS患者的CT特征表现;而HV-BCS则呈第一肝门“扇形”强化,肝静脉可见狭窄、闭塞及充盈缺损,肝尾状叶增大多见,多伴肝内侧支循环开放,常见脾脏增大。结论有服用土三七史、病程短、病情急、肝功能损伤重为PA-HSOS临床特征表现;第二肝门处“爪形”强化、肝静脉变细但通畅、肝尾状叶体积不大、肝内侧枝循环少见、门静脉周围晕征是其特征CT表现,易于鉴别HV-BCS。

Objective To study the clinical,liver injury and CT features of patients with Tusanqi-induced hepatic sinusoidal obstruction syndrome(PA-HSOS),so as to lay a foundation for the early diagnosis and treatment of PA-HSOS.Methods The clinical data and CT images of 31 patients with PA-HSOS were collected and compared with the data of 46 patients with hepatic venous Budd-Chiari syndrome(HV-BCS)who were treated at the same time.Results Compared with HV-BCS,PA-HSOS patients were more common in hyperacute/acute phase,older,and had higher degree of liver injury."Claw-shaped"enhancement at the second porta hepatis,thin but unobstructed hepatic segments of the hepatic vein and inferior vena cava,small caudate lobe,rare medial hepatic branch circulation,and periportal halo sign were CT features of PA-HSOS patients on the other hand.HV-BCS showed"fan-shaped"enhancement of the first hepatic hilum,hepatic vein stenosis,occlusion and filling defect,enlarged caudate lobe,often with open medial hepatic branch circulation,and often enlarged spleen.Conclusion The clinical features of PA-HSOS include short course of disease,acute disease,and severe liver function damage;"claw-shaped"enhancement at the second porta hepatis,thin but unobstructed hepatic veins,small caudate lobe,and intrahepatic branch circulation are rare.Periportal halo sign is its characteristic CT imaging manifestation,which is easy to identify HV-BCS.