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BMJ：肝门静脉积气——案例报道

2016-02-18 Mechront 译 MedSci原创

肝门静脉积气血管坏死
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患者女，74岁，因“寒颤、腹部不适2周”就诊。实验室指标提示炎症标志物升高，肝功表现为胆汁淤积。腹部超声和磁共振胰胆管成像未见明显异常。CT提示：肝门静脉积气(HPVG) ，左腰大肌脓肿。此时患者诊断可明确为：肝门静脉积气。因患者临床表现快速恶化，对其进行了急诊手术。术中发现患者伴有憩室脓肿和肠系膜下静脉破裂。最终对患者进行肠切除术+结肠造口术，术后患者恢复得很好。HPVG指由于各种原因导致气体在

患者女，74岁，因“寒颤、腹部不适2周”就诊。

实验室指标提示炎症标志物升高，肝功表现为胆汁淤积。

腹部超声和磁共振胰胆管成像未见明显异常。CT提示：肝门静脉积气(HPVG) ，左腰大肌脓肿。


此时患者诊断可明确为：肝门静脉积气。

因患者临床表现迅速恶化，对其进行了急诊手术。术中发现患者伴有憩室脓肿和肠系膜下静脉破裂。最终对患者进行肠切除术+结肠造口术，术后患者恢复得很好。

HPVG指由于各种原因导致气体在门静脉及其肝内门静脉分支异常积聚形成的影像学征象，其发生常与肠道局部缺血有关，会导致约75%的死亡率。疾病的发生可以伴有严重腹腔感染；由于肠道原因等可以继发胆汁淤积表现。

原始出处：

S Desbruslais, S Adegbola,et al.Abdominal discomfort with an alarming scan.BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i830

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1847904, encodeId=4eed184e904b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Jul 04 04:32:00 CST 2016, time=2016-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697295, encodeId=0d97169e29509, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Apr 04 12:32:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65388, encodeId=9c4165388ec, content=嗯，肝内门静脉有没有积气？, beContent=null, objectType=article, channel=null, level=null, likeNumber=207, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=23bd1690776, createdName=小丸子1995, createdTime=Wed Feb 24 16:07:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435142, encodeId=22f414351421d, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Feb 20 08:32:00 CST 2016, time=2016-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=64821, encodeId=8cea6482134, content=阿，这样阿, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90ea1614944, createdName=huangwukui, createdTime=Fri Feb 19 22:46:00 CST 2016, time=2016-02-19, status=1, ipAttribution=)]
    2016-07-04 gaoxiaoe

    #BMJ#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1847904, encodeId=4eed184e904b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Jul 04 04:32:00 CST 2016, time=2016-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697295, encodeId=0d97169e29509, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Apr 04 12:32:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65388, encodeId=9c4165388ec, content=嗯，肝内门静脉有没有积气？, beContent=null, objectType=article, channel=null, level=null, likeNumber=207, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=23bd1690776, createdName=小丸子1995, createdTime=Wed Feb 24 16:07:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435142, encodeId=22f414351421d, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Feb 20 08:32:00 CST 2016, time=2016-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=64821, encodeId=8cea6482134, content=阿，这样阿, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90ea1614944, createdName=huangwukui, createdTime=Fri Feb 19 22:46:00 CST 2016, time=2016-02-19, status=1, ipAttribution=)]
    2016-04-04 fusion

    #静脉#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1847904, encodeId=4eed184e904b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Jul 04 04:32:00 CST 2016, time=2016-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697295, encodeId=0d97169e29509, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Apr 04 12:32:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65388, encodeId=9c4165388ec, content=嗯，肝内门静脉有没有积气？, beContent=null, objectType=article, channel=null, level=null, likeNumber=207, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=23bd1690776, createdName=小丸子1995, createdTime=Wed Feb 24 16:07:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435142, encodeId=22f414351421d, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Feb 20 08:32:00 CST 2016, time=2016-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=64821, encodeId=8cea6482134, content=阿，这样阿, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90ea1614944, createdName=huangwukui, createdTime=Fri Feb 19 22:46:00 CST 2016, time=2016-02-19, status=1, ipAttribution=)]
    2016-02-24 小丸子1995

    嗯，肝内门静脉有没有积气？

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1847904, encodeId=4eed184e904b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Jul 04 04:32:00 CST 2016, time=2016-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697295, encodeId=0d97169e29509, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Apr 04 12:32:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65388, encodeId=9c4165388ec, content=嗯，肝内门静脉有没有积气？, beContent=null, objectType=article, channel=null, level=null, likeNumber=207, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=23bd1690776, createdName=小丸子1995, createdTime=Wed Feb 24 16:07:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435142, encodeId=22f414351421d, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Feb 20 08:32:00 CST 2016, time=2016-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=64821, encodeId=8cea6482134, content=阿，这样阿, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90ea1614944, createdName=huangwukui, createdTime=Fri Feb 19 22:46:00 CST 2016, time=2016-02-19, status=1, ipAttribution=)]
    2016-02-20 zhouqu_8

    #门静脉#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1847904, encodeId=4eed184e904b1, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Jul 04 04:32:00 CST 2016, time=2016-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697295, encodeId=0d97169e29509, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Apr 04 12:32:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65388, encodeId=9c4165388ec, content=嗯，肝内门静脉有没有积气？, beContent=null, objectType=article, channel=null, level=null, likeNumber=207, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=23bd1690776, createdName=小丸子1995, createdTime=Wed Feb 24 16:07:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435142, encodeId=22f414351421d, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Feb 20 08:32:00 CST 2016, time=2016-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=64821, encodeId=8cea6482134, content=阿，这样阿, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90ea1614944, createdName=huangwukui, createdTime=Fri Feb 19 22:46:00 CST 2016, time=2016-02-19, status=1, ipAttribution=)]
    2016-02-19 huangwukui

    阿，这样阿

    0

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