肝門靜脈氣體於急性腹痛的臨床預後

研究背景：肝門靜脈氣體（Hepatic portal venous gas, HPVG）為不祥的影像學徵兆，與一些危急的腹部疾病相關聯，且需要急診手術治療。本研究的目的是要表明HPVG於急性腹痛病人的臨床處理和預後。材料與方法 : 在台中榮民總醫院使用以下關鍵詞回顧性搜查了患者：肝門靜脈氣體，腸缺血，腸壁積氣，腸阻塞和消化性潰瘍穿孔。從2004年2月至2013年12月共有14例。結果 : 男生與女生比例為1:1，年紀為45至87歲。14例患者中，11例接受手術治療。 8例腸缺血，2例患者粘連性腸阻塞，1例十二指腸潰瘍穿孔，1例小腸炎和兩個病人有大腸炎。全部的死亡率為42.8％。缺血相關死亡率為75％。結論 : 肝門靜脈氣體不是手術的適應症。腸缺血的死亡率高，存活患者因為多個潛在疾病，手術後遺症及年紀大，所以通常無法擁有良好的生活品質。建議術前需要仔細評估此類病人。

Purpose: Hepatic portal venous gas (HPVG), ominous radiological sign, is associated with some critical abdominal disease, which required emergent operation. The purpose of this study is to show the clinical management and outcomes of HPVG in acute abdomen.Methods: We retrospective searched the patient with the key words: HPVG, bowel ischemia, pneumatosis intestinalis, bowel obstruction and perforated peptic ulcer at a tertiary care academic medical center. There were 14 patients obtained from Feburary 2004 to December 2013.Results: There were seven males and seven females who were 45-87 years old. Of the 14 patients, 11 underwent surgical intervention. Eight patients had bowel ischemia, two patients had adhesive intestinal obstruction, one patient had duodenal ulcer with perforation, one patient had enteritis and two patients had colitis. The overall mortality rate was 42.8%. The mortality rate related with bowel ischemia was 75%.Conclusions: HPVG is not an indication for surgical intervention. The mortality of bowel ischemia was high and the survived patients usually could not have a good quality of life because of the multiple underlying disease, sequela of operation and old age. Carefully evaluation of such patient before operation was suggested.