经颈静脉途径搅拌溶栓治疗急性门静脉血栓的临床疗效  

Clinical efficacy of agitation thrombolysis via transjugular access for treatment of acute portal vein thrombosis

作　　者：王朝阳[1] 任建庄[1] 韩新巍[1] 张文广[1] 张庆辉[1] 陈鹏飞[1] 赵国瑞[1] 

机构地区：[1]郑州大学第一附属医院介入科,河南省郑州市450052

出　　处：《世界华人消化杂志》2016年第14期2225-2230,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨经颈静脉途径搅拌溶栓治疗急性门静脉血栓(portal vein thrombosis,PVT)的临床疗效.方法:回顾性分析2012-10/2015-03郑州大学第一附属医院介入科收治PVT 13例,经颈静脉肝内穿刺进入门静脉,首先应用搅拌技术溶解血栓,若有门静脉高压则行门体分流术后留置导管于血栓段溶栓.记录观察手术成功率、溶栓时间、溶栓效果、并发症,CT及彩超随访门静脉及分流道通畅情况.结果:13例患者手术成功12例;分流患者8例1例术后第2天确诊小肠广泛坏死,给予切除9 d后死亡.其余11例患者术后复查C T门静脉再通均大于90%,术前与术后血栓占据管腔的范围相比差异有统计学意义(P<0.01)临床症状如腹痛、腹胀、消化道出血等均缓解或消失.并发症主要包括:1例患者术中出现包膜下出血,未能手术成功;1例患者死于肠道坏死;1例分流患者术后3 mo出现肝性脑病(2期);1例患者溶栓过程中出现血尿随访过程中,1例7 mo出现分流道狭窄,给予球囊扩张后血流通畅.结论:经颈静脉途径搅拌溶栓是治疗PVT安全有效的方法.AIM：To evaluate the clinical efficacy of agitation thrombolysis via transjugular access for the treatment of acute portal vein thrombosis.METHODS：Thirteen patients with acute portal vein thrombosis treated from October2012 to March 2015 at our hospital were analyzed retrospectively.The portal vein was approached via the transjugular intrahepatic portosystemic route,followed by agitation thrombolysis to resolve the thrombi.The need for transjugular intrahepatic portosystemic shunt（TIPS） was based on the presence of portal hypertension,and then a catheter was indwelled into the thrombi.The success rate,thrombolytic therapeutic time and effect,and complications were observed.Computed tomography and Doppler ultrasound were performed to follow the patency of the portal vein and TIPS stent.RESULTS：Agitation thrombolysis were successfully created in 12 patients.Of 8patients who underwent TIPS,1 underwent wide resection due to confirmed extensive intestinal necrosis on postoperative day 2;however,the patient died 9 d later.In the remaining 11 patients,the portal vein was recanalized 〉90%as revealed by CT findings.There was a significant difference in lumen occupancy between pre- and post-operation（P〈0.01）.The clinical symptoms such as abdominal pain,ascites,and gastrointestinal bleeding were all relieved or disappeared.The complications were mainly as follows：intraoperative subcapsular bleeding in one patient;death due to intestinal necrosis in one patient;hepatic encephalopathy at 3 mo in one patient with TIPS;and hematuria during thrombolysis in one patient.During follow-up,TIPS stent stenosis was noted in one patient at7 mo and treated by balloon angioplasty.CONCLUSION：Agitation thrombolysis via transjugular access for the treatment of acute portal vein thrombosis is safe and effective.

关 键 词：门静脉血栓 搅拌溶栓 经颈静脉途径 

分 类 号：R575[医药卫生—消化系统]