一个罕见的血动力学突发性肝损伤病例:创伤性外流阻断
Keita Sato1, Natsuki Hashiba2, Junji Uraki3
1Department of Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie, 516-0815, Japan. gummi.chocolate.pine@hotmail.com.
International journal of emergency medicine
|October 1, 2025
概括
一个新的血管学发现,创伤性外流阻断 (TOFB),可以预测肝脏创伤后血管栓塞 (AE) 后的主要肝脏亡 (MHN). 早期识别TOFB可以改善严重肝损伤患者的治疗结果.
科学领域:
- 放射学 放射学是一门学科.
- 血管外科 血管外科
- 创伤外科 手术 创伤外科
背景情况:
- 非手术管理 (NOM) 是粗的固体器官损伤的标准,血管栓塞 (AE) 对于肝脏创伤血静至关重要.
- AE可以破坏肝脏的血液流动,可能导致严重的肝脏亡 (MHN),这是一个严重的并发症.
- 早期预测MHN风险,特别是使用血管学发现,是具有挑战性的,而且报告不足.
研究的目的:
- 报告在血管造影期间观察到的罕见的肝内血动力学现象.
- 为了识别肝损伤血管栓塞 (AE) 后主要肝亡 (MHN) 的潜在早期预测因素.
主要方法:
- 一个案例报告,一名32岁的男性在机动车碰撞后患有III级肝损伤.
- 血管造影显示,在动脉阶段左门静脉分支的对比度增强,与逆行变暗和肝脏静脉外流受损.
- 这种模式被称为创伤性外流阻断 (TOFB);进行AE,然后发展MHN.
主要成果:
- 已确定的血液动力学模式,创伤性外流阻断 (TOFB),涉及无静脉排水的跨鼻状动脉到门的流动.
- 尽管有TOFB,但进行了血管栓塞,导致不输血,随后发生了严重的肝硬化,需要分段切除.
- 组织病理学表明静脉压缩可能是出流受损的原因.
结论:
- 创伤性外流阻塞 (TOFB) 是一种新的血管学发现,表明肝静脉堵塞.
- 在肝创伤中血管栓塞后,TOFB可能是主要肝死 (MHN) 的早期预测因素.
- 早期识别TOFB可以指导治疗和监测,可能改善严重肝损伤病例的结果.
相关概念视频
01:28Esophageal Varices-II: Clinical Features and Management
374
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
374
01:24Flail Chest-I
618
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
618
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
903
Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
903