Wei Hao-Ran, Shan Yu-Qiang, Dong Fan-He, Zhou Lin-Po, Yang Ye-Bin, Shi Jing, Ji Cheng-Hao, Kong Wen-Cheng
The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, China.
Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Zhejiang, China.
Front Med (Lausanne). 2025 May 9;12:1540418. doi: 10.3389/fmed.2025.1540418. eCollection 2025.
Hepatic portal venous gas (HPVG) is often regarded as a critical warning sign and has poor patient prognosis if appropriate treatment measures are not promptly administered. There is significant heterogeneity in clinical manifestations, diagnostic approaches, and outcomes among patients with HPVG; hence, this study aimed to analyze the clinical characteristics of patients with HPVG and explore more effective treatment methods to provide valuable references for future clinical treatment strategies.
A total of 21 patients diagnosed with HPVG using computed tomography at the First People's Hospital of Hangzhou between January 2014 and October 2024 were retrospectively analyzed. A comprehensive analyses of the sex, age, laboratory test results, reasons for admission, comorbidities, treatment methods, and outcomes of patients were done.
The mean age of the 21 patients (13 men and 8 women) was 61.7 years. Patients presented with decreased red blood cell and hemoglobin counts, and increased white blood cell, neutrophil, C-reactive protein, and D-dimer levels. The main etiologies of HPVG were peritonitis (52.4%), post-abdominal surgery (47.6%), intestinal necrosis (33.3%), and gastrointestinal bleeding (28.6%), while the common comorbidities were peritonitis (52.4%), hypertension (52.4%), and coronary heart disease (23.8%). The overall mortality rate of patients with HPVG was 28.6%, and most of the deceased patients had bowel necrosis. Platelet count [odds ratio (OR): 0.979; 95% confidence interval (CI): 0.962-0.997; = 0.024] and neutrophil levels, (OR: 1.161; 95% CI: 1.019-1.323; = 0.025), and the presence of hypertension (OR: 15.750; 95% CI: 1.424-174.246; = 0.025) and peritonitis (OR: 15.750; 95% CI: 1.424-174.246; = 0.025) were significantly associated with the likelihood of requiring surgical intervention. Most patients had a good prognosis after surgical treatment.
This study systematically described the clinical characteristics, etiologies, comorbidities, and prognosis of patients with HPVG and identified predictors indicating the need for surgical intervention.
肝门静脉积气（HPVG）常被视为一种危急警示信号，若未及时采取适当治疗措施，患者预后较差。HPVG患者在临床表现、诊断方法和预后方面存在显著异质性；因此，本研究旨在分析HPVG患者的临床特征，并探索更有效的治疗方法，为未来临床治疗策略提供有价值的参考。
回顾性分析2014年1月至2024年10月期间在杭州市第一人民医院通过计算机断层扫描诊断为HPVG的21例患者。对患者的性别、年龄、实验室检查结果、入院原因、合并症、治疗方法和预后进行了全面分析。
21例患者（13例男性和8例女性）的平均年龄为61.7岁。患者出现红细胞和血红蛋白计数降低，白细胞、中性粒细胞、C反应蛋白和D-二聚体水平升高。HPVG的主要病因是腹膜炎（52.4%）、腹部手术后（47.6%）、肠坏死（33.3%）和胃肠道出血（28.6%），而常见的合并症是腹膜炎（52.4%）、高血压（52.4%）和冠心病（23.8%）。HPVG患者的总体死亡率为28.6%，大多数死亡患者患有肠坏死。血小板计数[比值比（OR）：0.979；95%置信区间（CI）：0.962-0.997；P = 0.024]、中性粒细胞水平（OR：1.161；95%CI：1.019-1.323；P = 0.025），以及高血压（OR：15.750；95%CI：1.424-174.246；P = 0.025）和腹膜炎（OR：15.750；95%CI：1.424-174.246；P = 0.025）的存在与需要手术干预的可能性显著相关。大多数患者手术治疗后预后良好。
本研究系统地描述了HPVG患者的临床特征、病因、合并症和预后，并确定了提示需要手术干预的预测因素。
