Shrestha S M
Liver Unit, Bir Hospital, Kathmandu, Nepal.
Am J Gastroenterol. 1995 Feb;90(2):303-6.
Chronic liver disease due to obstructive lesion of the hepatic inferior vena cava (IVC) is common in Nepal. This study presents 10 patients with cavographically documented membranous obstruction of the hepatic IVC with minimal symptoms and a benign course. One patient with an incomplete membrane had balloon dilation of the lesion. The duration of the disease among these patients varied from 5 months to 23 yr; eight patients have been followed for periods varying from 1 to 15 yr, with an average of 6 yr. In developing countries, the possibility of hepatic IVC obstruction should be considered in the differential diagnosis of hepatomegaly or hepatosplenomegaly, even in the absence of ascites and external cava-caval collateral. Routine liver and hematology tests in these patients usually are normal, and liver biopsy findings may not always be specific. Ultrasound, however, has proved to be the best diagnostic procedure for the condition. The lesion can be demonstrated easily by cavography. The disease runs a chronic course, and, in the absence of resistant ascites or repeated variceal bleeding, surgical procedures such as cavoatrial bypass, which are a significant cause of death in developing countries, may be contra-indicated.
尼泊尔因肝下腔静脉（IVC）阻塞性病变导致的慢性肝病很常见。本研究报告了10例经腔静脉造影证实为肝IVC膜性阻塞且症状轻微、病程良性的患者。1例膜不完整的患者对病变进行了球囊扩张。这些患者的病程从5个月到23年不等；8例患者的随访时间从1年到15年不等，平均为6年。在发展中国家，即使没有腹水和腔静脉侧支循环，在肝肿大或肝脾肿大的鉴别诊断中也应考虑肝IVC阻塞的可能性。这些患者的常规肝脏和血液学检查通常正常，肝脏活检结果也不一定具有特异性。然而，超声已被证明是诊断该病的最佳方法。通过腔静脉造影可以很容易地显示病变。该病病程呈慢性，在没有顽固性腹水或反复静脉曲张出血的情况下，在发展中国家作为主要死亡原因的诸如腔房分流术等外科手术可能是禁忌的。
