26例肝窦阻塞综合征临床及影像分析

目的了解肝窦阻塞综合征患者的临床特点及影像特征。方法回顾性分析2010年11月至2019年2月在解放军总医院第五医学中心住院诊治的26例肝窦阻塞综合征患者的临床资料,归纳总结其主诉、临床表现、实验室检查、影像学特征及病因。结果26例肝窦阻塞综合征患者以腹胀、乏力、纳差、腹水为主要症状,1例为肝移植术后患者,1例为肾移植术后患者,均有明确的化学治疗史,1例患者病因不明,23例患者有明确的中草药服用史,其中21例服用土三七。ALT升高17例,AST升高20例,糖类抗原CA125升高23例。CT及MR影像学显示,脾脏增大11例,腹水24例,肝脏密度及信号不均21例,增强扫描强化不均匀23例,肝静脉变细或显示不清11例。结论肝窦阻塞综合征的病因以服用土三七为主,临床表现为腹胀、乏力、纳差,可有肝功能异常及CA125升高,影像学表现以肝脾肿大、腹水、肝脏密度及信号不均,增强扫描强化不均及肝静脉变细或显示不清为主。

Clinical and imaging analysis of 26 cases of hepatic sinusoidal obstruction syndrome

Objective To analyze the clinical and imaging features of 26 patients with hepatic sinusoidal obstruction syndrome(SOS),and to provide experience for clinical diagnosis and treatment of SOS.Methods The clinical data of 26 patients with SOS hospitalized in the Fifth Medical Center of Chinese People's Liberation Army General Hospital from November 2010 to February 2019 were analyzed retrospectively,symptoms and signs,laboratory examinations,imaging features and etiology were summarized.Results In 26 patients with SOS,abdominal distension,fatigue,anorexia and ascites were the main symptoms and signs.Of these patients,1 after liver transplantation and 1 after renal transplantation had chemotherapy history,1 patient was with unknown etiology,and the other 23 patients had a history of taking Chinese herbal medicine,among which the most had taken the gynura segetum(80.8%).Laboratory examinations showed that alanine aminotransferase(ALT)elevated in 17 cases,aspartate transaminase(AST)elevated in 20 cases,cancer antigen 125(CA125)elevated in 23 cases.The imaging features of computed tomography and magnetic resonance were similar,including 11 cases of splenomegaly,24 cases of ascitic fluid,21 cases of uneven density and signal intensity of liver,23 cases of inhomogeneous enhancement in enhanced scan,and 11 cases of thinner or unclear hepatic veins.Conclusion The main cause of SOS is taking gynura segetum,the clinical manifestations are abdominal distention,fatigue,anorexia,abnormal liver function and elevated CA125.The imaging features are hepatosplenomegaly,ascites,uneven liver density and signal,inhomogeneous enhancement of enhanced scanning and thinner or unclear hepatic veins.