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目的探讨中药土三七治儿童肝小静脉闭塞病的病因及诊断。方法总结2例儿童肝小静脉闭塞病的临床和影像学表现,并复习相关文献。结果患儿临床表现为顽固性大量腹水,肝脏增大,腹壁静脉显露、脐周及侧腹壁无静脉曲张。肝功能异常,腹部增强CT扫描:肝实质内不均匀强化,呈高低密度相间的斑片状,肝静脉显示不清,下腔静脉肝段变扁,远端不扩张亦无侧支循环。根据临床表现,病前1-2月服中药病史,结合腹部CT以及目前肝小静脉闭塞病的诊断标准,诊断为儿童肝小静脉闭塞病。停用土三七并给予抗凝治疗病情逐渐缓解。结论儿童长期服用土三七制剂可致肝小静脉闭塞病。腹部增强CT扫描典型特征有助于临床诊断。抗凝治疗有一定疗效。
Objective To investigate the etiology and diagnosis of occlusion of hepatoprotectant in children treated with traditional Chinese medicine. Methods The clinical and radiographic findings of 2 cases of occlusion of hepatic venules in children were summarized and related literatures were reviewed. Results The clinical manifestations of children with refractory massive ascites, liver enlargement, abdominal veins revealed, umbilical and lateral abdominal varicose veins. Hepatic dysfunction, abdominal enhanced CT scan: Hepatic parenchyma heterogeneity, high and low density of the patchy, hepatic veins showed unclear, inferior vena cava liver segment becomes flat, distal dilatation nor collateral circulation. According to clinical manifestations, 1-2 months before taking the disease history of Chinese medicine, combined with abdominal CT and the current diagnosis of occlusive disease of hepatic venules, diagnosed as occlusion of the hepatic venules. Disable soil and seven seven and give anticoagulant therapy gradually eased. Conclusion Long-term use of soil Sanqi preparations can cause hepatic veno-occlusive disease. Abdominal enhanced CT scan typical features help clinical diagnosis. Anticoagulant therapy has a certain effect.