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1 病例报告患者女,36岁.因渐进性下肢水肿3个月,于1993年2月19日入院.应用利尿剂治疗,水肿可减轻或消退,但数日后可再现.既往身体健康,无心、肝、肾及其它疾病史.入院前3年连续服用复方18甲短效避孕滴丸,近10个多月来改服长效复方18甲避孕片,入院前1个月停药.体检,T 36.7℃,P 80次/分,R 18次/分,BP 16/10.5kPa,眼睑无水肿,心肺无异常,肝于肋下可及边缘,脾不大,腰腹部可见小片状毛细血管扩张,侧腹壁静脉隐约可见,双下肢轻度指凹性水肿.腹部B超可见少量腹水,胆囊壁水肿、增厚,肝不大,心脏彩超无异常.肝功能正常,A/G为4.0/2.7,血BUN 4.1mmol/L,Cr 80μmol/L,血小板100×10~9/L,尿蛋白(+)～(±),24小时尿蛋白定量229mg.于3月29日、4月7日分别做下腔及上腔静脉造影,发现下腔静脉于第9胸椎上缘由内下向外上柱状阻塞,近端有1cm的环形狭窄,阻塞远端的下腔静脉、腰静脉、椎前静脉、奇静脉均有迂曲扩张,肝静脉扩张明显,后经手术证实造影诊断,实施搭桥手术后水肿消退、尿蛋白消失.随访两年无异常.2 讨论
1 Case Report Female, 36 years old, due to progressive edema of the lower extremities for 3 months and was admitted on February 19, 1993. Treatment with diuretics may reduce or dissipate edema but may be reproducible in a few days. Previously healthy, Liver, kidney and other diseases .Be admitted to hospital for three consecutive years before taking compound 18 short-term contraceptive pills, nearly 10 months to change long-acting compound 18 A contraceptive tablets, withdrawal 1 month before admission. Physical examination, T 36.7 ℃, P 80 beats / min, R 18 beats / min, BP 16 / 10.5kPa, eyelid without edema, no abnormality of heart and lungs, liver could reach the edge of the ribs, spleen is not large, , Side veins looming vaguely, both lower extremity mild concave edema .B Abdominal ultrasound can see a small amount of ascites, gallbladder wall edema, thickening, liver is not large, no abnormal color Doppler ultrasound. Liver function is normal, A / G is 4.0 / 2.7 , Blood BUN 4.1mmol / L, Cr 80μmol / L, platelet 100 × 10 ~ 9 / L, urinary protein (+) ~ (±), 24h urine protein quantitation 229mg. On March 29, April 7 To do inferior vena cava and superior vena cava angiography and found that the inferior vena cava on the 9th edge of the upper and lower columnar obstruction from the inside out, the proximal 1cm ring narrow, obstruction distal inferior vena cava, lumbar vein, anterior vertebral vein, Strange Arterial tortuous dilatation, hepatic vein dilatation significantly, confirmed by surgery after angiography diagnosis, bypass surgery after edema subsided, urinary protein disappeared. No abnormalities were followed up for two years.2 Discussion