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  • 朱峰锋,彭爽,司马辉,宋金超,曹鹏,陈国栋,韩东.肝创伤性破裂修补术后19年肝动脉-门静脉瘘1例并文献分析[J].第二军医大学学报,2019,40(7):816-819    [点击复制]
  • ZHU Feng-feng,PENG Shuang,SIMA Hui,SONG Jin-chao,CAO Peng,CHEN Guo-dong,HAN Dong.Hepatic arterioportal fistula 19 years after liver traumatic rupture repair surgery: a case report and literature review[J].Acad J Sec Mil Med Univ,2019,40(7):816-819   [点击复制]
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肝创伤性破裂修补术后19年肝动脉-门静脉瘘1例并文献分析
朱峰锋1,2,彭爽3,司马辉1,宋金超4,曹鹏2,陈国栋2,韩东2*
0
(1. 海军军医大学(第二军医大学)东方肝胆外科医院肝外五科, 上海 200438;
2. 南华大学附属第一医院肝胆外科, 衡阳 421001;
3. 暨南大学医学部生理学教研室, 广州 510632;
4. 海军军医大学(第二军医大学)东方肝胆外科医院麻醉科, 上海 200438
*通信作者)
摘要:
通过对1例临床罕见的门静脉高压症—肝动脉门静脉瘘(HAPF)进行病例报道,,探讨肝脏创伤及医源性有创检查对肝脏及机体产生的影响。方法:报告1例幼年创伤所致肝脏破裂行修补术后19年出现HAPF资料,结合国内外文献回顾性分析发生病因及诊疗现状。结论:创伤性及医源性肝动脉-门静脉瘘国内外罕见,本病例报道通过高分辨率CT及血管三维重建技术清晰展现瘘口情况并对其进行诊断及病因分析,致伤因素导致肝动脉与门静脉系统间发生分流,致压力较高的大量动脉血涌入门脉系统,形成门静脉高压;凡是能够破坏肝脏正常组织结构的创伤及医源性有创操作均可能引起HAPF,应将HAPF明确列为肝脏创伤及医源性有创诊疗后的并发症之一;急性肾功能衰竭、急性肝功能衰竭、急性心功能衰竭均是HAPF罕见临床表现。
关键词:  门静脉高压  肝动脉-门静脉瘘  医源性创伤  X线计算机体层摄影术
DOI:10.16781/j.0258-879x.2019.07.0816
投稿时间:2018-11-01修订日期:2019-04-24
基金项目:国家自然科学基金(81371511).
Hepatic arterioportal fistula 19 years after liver traumatic rupture repair surgery: a case report and literature review
ZHU Feng-feng1,2,PENG Shuang3,SIMA Hui1,SONG Jin-chao4,CAO Peng2,CHEN Guo-dong2,HAN Dong2*
(1. Department of Hepatic Surgery(Ⅴ), Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 200438, China;
2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China;
3. Department of Physiology, Faculty of Medical Science, Jinan University, Guangzhou 510632, Guangdong, China;
4. Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 200438, China
*Corresponding author)
Abstract:
Abstract: Objectives: This article tries to realize the impact of liver trauma and iatrogenic invasive examination on liver and body through 1 rare clinical case report of hepatic artery portal venous fistula (HAPF). Methods:We combined the data of 19 years after live rupture repair operation which was caused by juvenile trauma with the domestic and foreign literatures to analyzed the cause and the present situation of diagnosis and treatment. Conclusions: Traumatic and iatrogenic hepatic artery portal vein fistula is rare at home and abroad, we explored etiology and diagnosis by high resolution three-dimensional reconstruction of CT and 3D vascular reconstruction technology in the paper. Then, we suspect that it was arterial-portal venous shunt which caused by trauma contributes to portal hypertension, and we conclude that all liver trauma and invasive procedure may result in HAPF. Furthermore, we suggest that the HAPF should be clearly classified as one of complications in liver trauma and iatrogenic invasive procedures. Finally,we learned that neither one of acute renal failure, acute liver failure and acute heart failure is a rare clinical presentation of HAPF.
Key words:  portal hypertension  hepatic arterioportal fistula  iatrogenic trauma  X-ray computed tomography