Clinical Analysis Of 80 Cases Of Hepatic Sinus Obstruction Syndrome

Objective:Hepatic sinusoidal obstruction syndrome(HSOS),also known as hepatic veno occlusive disease(HVOD),is a kind of hepatic vascular disease.The main clinical manifestations are ascites,hepatomegaly,abdominal pain,jaundice,and abdominal distension.Foreign reports mainly occur in bone marrow hematopoietic stem cell transplantation(HSCT),or in patients treated with large doses of chemotherapy or radiotherapy.In China Patients with Chinese herbal medicines containing pyrrolidine alkaloids are often found,such as gynura segetum.The disease is a rare clinical disease.However,in recent years,there has been an increasing trend,its pathogenesis is not clear,and the clinical manifestations are not obviously specific,so It is often diagnosised delaying.Currently,there is no effective treatment,and the mortality of severe patients is higher,and the prognosis is poor.Therefore,early diagnosis and reasonable treatment are greatly significative to improve the prognosis of patients.This study retrospectively analyzed the etiology,clinical manifestations,laboratory and imaging examinations,pathological examination and treatment of 80 HSOS patients in our hospital,and in order to improve the understanding of hepatic sinusoidal obstruction syndrome.It is helpful for early diagnosis and treatment and to improve the prognosis of patients.Clinical data of 80 cases of HSOS patients admitted to The First Affiliated Hospital of Zhengzhou University from June 2010 to June 2017 were retrospectively analyzed for etiology,clinical manifestation,laboratory examination,imaging manifestations,pathological features and treatment.Results:Of the 80 cases,58 cases had the history of taking gynura segetum,accounting for 72.5%.The main clinical manifestations were abdominal distension,ascites,hepatomegaly,jaundice,and abdominal pain.Laboratory examinations indicated liver function injury,coagulation function abnormality,increased serum CA125 level,and decreased platelet count.The enhanced computed tomography(CT)showed characteristic “map” or “patchy ”enhancement.Color Doppler ultrasound showed hepatomegaly,the hepatic vein was thin or unclear,and blood flow slowed down.The pathological examination showed hepatic sinusoid dilation and hyperemia,the thickening,stenosis or occlusion of the small vein wall in the liver.The main therapy was anticoagulant treatment.68 cases were treated with anticoagulant therapy,13 of them were cured,50 were improved,and 5 were not cured;9 cases were treated with glucocorticoid,1 of them was cured,6 were improved,and 2 were not cured;one case was cured by liver transplantation;2 cases were improved by routine treatment,for example,liver protection,diuresis and nutritional support etc.Conclusion:Currently,HSOS caused by gynura segetum is more common in our country,and the incidence rate has increased.Patients with the major clinical manifestations as unexplained ascites,painful hepatomegaly,jaundice,and abdominal distension,need heightened alterness about the possibility of HSOS,inquire into the medical history detailedly,eliminate with or without the history of contact with gynura segetum,and perfect abdominal color doppler ultrasound,enhanced CT or MRI examination.Early diagnosis and treatment is of great significance to improve the prognosis of patients.The liver pathological biopsy is the gold standard for diagnosis Materials:of the disease,but clinical application has certain limitations.It can be primary diagnosed according to the medical history,clinical manifestation,laboratory examination,and typical image characteristic.At present,HSOS has no specific therapeutic methods,and the clinical focus is to prevent and improve the understanding of the disease by the general clinicians and the people,and the early treatment of anticoagulation can achieve better curative effect.