7例肝门静脉积气的临床特征分析

Clinical characteristics of 7 cases of hepatic portal venous gas

目的:总结分析肝门静脉积气(hepatic portal venous gas,HPVG)患者的临床特点,提高临床医生对HPVG的诊疗水平。方法:回顾性分析2017年1月至2021年1月北京大学第三医院急诊收治的7例成人HPVG患者,包括患者一般资料、临床特点、实验室及影像学检查结果、原发疾病治疗方法、临床结局及预后。结果:共纳入7例HPVG患者,年龄中位数为67(63,81)岁。7例患者均为急性起病,腹痛为最多见及最主要的临床症状,其中6例患者入院后出现休克。所有患者经腹部CT检查后均发现肝门静脉及其分支的积气征象。7例HPVG患者中有4例为肠道病变所致,2例为缺血性疾病诱发,1例病因为急性胰腺炎。病例1、2、6经有效治疗后积气消失(其中2例患者行外科手术,术后预后良好,1例患者经保守治疗后好转出院)。有肠道缺血坏死并伴有休克、多器官功能障碍的患者预后差(病例3、4、5、7均死亡)。结论:CT是HPVG首选的诊断方法。成人HPVG的出现往往提示预后不良,合并休克、腹腔积液、腹膜炎则可能提示腹腔内肠管已出现缺血坏死,患者病死率高。临床医师需要对HPVG有正确的认识和高度的警惕性,及早发现并给予针对病因的积极治疗。

Objective:To summarize and analyze the clinical characteristics of patients diagnosed with hepatic portal venous gas(HPVG).Methods:This was a single center retrospective observational study.All of the patients were diagnosed with HPVG.The patients were admitted to Peking University Third Hospital from January 2017 to January 2021.Demographic characteristics,clinical manifestations,laboratory tests,abdominal imaging,treatment of the primary disease,and clinical outcomes of the patients were collected via electronic medical records.The study was approved by institutional review board and the information of all the patients was kept de-identified.Results:A total of seven cases were included in the study.The median age of the patients was 67(63,81)years.Six of the patients were male.The seven patients all presented with sudden onset of severe abdominal pain,which was the most common symptom.Six patients developed septic shock after admission.The signs of HPVG were detected by CT scans in all the patients,showing gas embolization.It might also be found as unique“aquarium sign”in abdominal ultrosonography.Four cases were caused by intestinal lesions,including acute volvulus,intestinal obstruction,and rectal abscess.Two were caused by ischemic bowel disease and the other one was caused by severe acute pancreatitis.The gas accumulation could disappear after effective anti-shock therapy and surgery(Cases 1,2,and 6).Two patients had good postoperative outcomes,and one patient was discharged after non-surgical treatment.However,the prognosis was poor in the patients with intestinal ischemia necrosis accompanied by shock and multiple organ dysfunction(Cases 3,4,5,and 7 all died).Conclusion:The HPVG patients generally have acute abdominal pain and show up at Emergency Department.The prognosis depends on the potential cause of HPVG.The mechanism and clinical management for the appearance of gas in the portal vein is not well understood.Patients complicated with shock,ascites,and peritonitis may have intestinal necrosis,which indicates surgical intervention and higher mortality.CT is the preferred diagnostic method in standard clinical practice.Physicians need to have a comprehensive understanding of the proactive diagnostic strategy,and active treatment for the primary disease.