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患者男,27岁,居住于长江血吸虫病疫区。1989年8月因急性血吸虫病住院行病原学治疗。1年半后出现腹壁静脉怒张,院外诊断:肝硬化,经护肝对症治疗,症状无改善。故来我院就诊。体格检查:营养一般,皮肤黏膜未见黄染,未见颈静脉怒张,右锁骨上有一蜘蛛痣。腹部平坦,脐两侧可见一平行走向的腹壁静脉怒张,宽约0.8 cm。其血流方向为自下而上。腹软,未及包块,无液性波动感。肝脏右锁骨中线肋下7.0 cm,剑突下4.5 cm,边缘整齐,质中等,无明显压痛。肝颈静脉回流征阴性。脾脏肋下3.5 cm。腹部叩诊未发现移动性浊音。双下肢无水肿。无血栓性静脉炎体征。实验室检查:血吸虫大便集卵(+)。血小板15×10~9/L。血清蛋白、肝功能、出血时间和凝血时间正常。HBsAg、HBeAg、抗-HBc 及 HBV-DNA、抗 HCV、HCV-RNA 均阴性。影像学检查:B 超检查:肝脏肋下6.5 cm,肝七肋厚10.5 cm,脾厚5.7 cm 脾和肾周静脉曲张开放。彩色多普勒超声:肝切面形态正常,肝内光点分布不均,肝内未见占位性病变,门静脉主干内径1.3 cm,血流为向肝性,肝中静脉、肝
Male patient, 27 years old, living in the Yangtze River schistosomiasis epidemic area. 1989 August due to acute schistosomiasis hospital etiological treatment. 1 and a half years after the emergence of abdominal venous distention, out-of-hospital diagnosis: cirrhosis, liver and symptomatic treatment, no improvement in symptoms. So come to our hospital. Physical examination: general nutrition, no yellow skin and mucous membranes, no jugular vein engorgement, there is a spider mole on the right clavicle. Abdomen flat, umbilical sides can be seen on both sides of a parallel to the ventral wall of the vein engorgement, width 0.8 cm. The direction of its blood flow from the bottom up. Abdominal soft, not mass, no liquid fluctuation. The right subclavian midline rib 7.0 cm, the xiphoid 4.5 cm, tidy edges, medium quality, no significant tenderness. Negative hepatic jugular vein reflux. Spleen ribs 3.5 cm. Peritoneal percussion no mobile dullness was found. No lower extremity edema. No thrombophlebitis signs. Laboratory tests: Schistosoma stool eggs (+). Platelets 15 × 10 ~ 9 / L. Serum protein, liver function, bleeding time and clotting time were normal. HBsAg, HBeAg, anti-HBc and HBV-DNA, anti-HCV, HCV-RNA were negative. Imaging examination: B-ultrasound: liver rib 6.5 cm, hepatic hepatic ribs thickness 10.5 cm, splenomegaly 5.7 cm spleen and perirenal varicose veins open. Color Doppler ultrasound: liver section morphology is normal, uneven distribution of light within the liver, the liver no space-occupying lesions, the main portal vein diameter 1.3 cm, blood flow to the liver, the middle of the vein, liver