土三七致肝小静脉闭塞病治疗的单中心回顾性研究

被引：41

作者：

王轶

诸葛宇征

张峰

张明

张玮

贺奇彬

邹晓平

机构：

[1] 南京大学医学院附属鼓楼医院消化科

来源：

中华消化杂志 | 2016年 / 36卷 / 12期

关键词：

土三七; 肝静脉闭塞性疾病; 肝素, 低相对分子质量; 华法林; 门体分流术, 经颈静脉肝内;

D O I：

暂无

中图分类号：

R575 [肝及胆疾病];

学科分类号：

100201 [内科学];

摘要：

目的探讨采用不同治疗方法对由食用土三七所致的肝小静脉闭塞病(HVOD)患者预后的影响。方法纳入2008年7月至2016年1月因食用土三七而导致HVOD的85例患者, 均给予基础保肝和改善微循环等对症治疗, 再根据不同治疗方案分成非抗凝治疗组、非抗凝治疗转经颈静脉肝内门体静脉分流术(TIPS)组、抗凝治疗组、抗凝治疗转TIPS组和抗凝-TIPS阶梯治疗组, 观察各组的临床疗效。统计学分析采用卡方检验。结果 22例未采用抗凝治疗的患者中, 6例(27.3%)临床治愈, 14例(63.6%)在治疗期间死亡, 2例(9.1%)因治疗无效而接受TIPS治疗并长期存活。63例采用低分子肝素联合华法林抗凝治疗的患者中, 6例(9.5%)死亡, 36例(57.1%)临床治愈, 治愈率高于非抗凝治疗组(χ2=5.820, P=0.016);另有21例患者接受TIPS治疗, 其中1例因手术失败而死于手术并发症, 其余患者均长期存活。抗凝-TIPS阶梯治疗组的临床治愈率为88.9%(56/63), 高于非抗凝治疗组, 差异有统计学意义(χ2=31.350, P<0.01)。结论与常规的保肝和对症治疗相比, 抗凝治疗显著提高了土三七所致HVOD患者的临床治愈率。抗凝-TIPS阶梯治疗则进一步提高了其治愈率。

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