超声引导下经皮经肝门静脉穿刺辅助溶栓治疗肝移植术后门静脉血栓  

Ultrasound-guided percutaneous transhepatic thrombolysis for treatment of portal vein thrombosis after liver transplantation

作　　者：罗佳[1] 林建伟[2] 苏丽娅[1] 林满霞[1] 范文哲[3] 谢晓燕[1] 田文硕[1] Luo Jia Lin Jianwei Su Liya Lin Manxia Fan Wenzhe Xie Xiaoyan Tian Wenshuo(Department of Medical Ultrasonics, Institute of Diagnostic and lnterventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China The Organ Transplantation Center, the Third People＇s Hospital of Shenzhen, Shenzhen 518020, China Department of Oncology Intervention, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Chin)

机构地区：[1]中山大学附属第一医院超声医学科,中山大学超声诊断与介入超声研究所,广州510080 [2]深圳市第三人民医院器官移植中心,深圳518020 [3]中山大学附属第一医院肿瘤介入科,广州510080

出　　处：《中国医师杂志》2017年第6期821-823,共3页Journal of Chinese Physician

摘　　要：目的探讨超声引导下经皮经肝门静脉穿刺辅助溶栓治疗肝移植术后门静脉血栓形成的有效性及安全性。方法回顾性分析2012年1月至2015年12月本中心肝移植术后门静脉主干血栓形成的患者6例（男5例，女1例，年龄41～65岁）。诊断标准为超声造影显示门静脉内充满实性低回声且呈无增强。在超声引导下，选择肝S8门静脉较粗分支，采用18GPTC针经皮经肝穿刺至门静脉分支后，置入导丝至门静脉主干。在DSA监视下，经导丝交换导管，注射碘对比剂再次证实门静脉血栓形成，交换置入溶栓导管并予以局部溶栓治疗。结果6例患者均成功于门静脉置入导丝，5例患者（移植术后2～60d）成功置入溶栓导管，1例患者（术后9年）门静脉主干闭塞溶栓导管置入失败。经5—11d尿激酶溶栓治疗后，5例复查门静脉血流通畅，取出溶栓导管，其中4例行门静脉球囊扩张术及支架植入术，随访16—31个月，5例患者均存活，且门静脉血流通畅，无血栓形成。无严重介入相关并发症及死亡。结论超声引导下经皮经肝门静脉穿刺辅助溶栓是治疗肝移植术后近期门静脉血栓有效且安全的方法。Objective To evaluate the effective and safety of ultrasound-guided percutaneous portal vein guide wire placement adjunct to thrombolytic catheter, which treating portal vein thrombosis after liver transplantation. Methods From Jan 2012 to Dec 2015, a total of 6 patients （5 male, I female, average age 50.6 years old, age range 41 -65 years old ） with portal vein thrombosis after liver transplantation were retrospectively studied. The diagnosis was confirmed by contrast enhanced ultrasound （CEUS） with hypoe- chonic and no enhancement in portal vein. With ultrasound-guided a 18-guage guide wire was placed in right branch of portal vein, and a guidewire was placement. After exchanging the catheter, the thrombosis was confirmed again by venography. A thrombolytic catheter was placed and local thrombolysis therapy was performed. Results The guidewires were successfully placed in 6 patients. The thrombolytic catheters were successfully placed in 5 patients （day 2 -60 after operation） , and failed in 1 patient （9 years after operation）. With 5 - 11 days urokinase injection, the patency of portal vein was found in 5 patients, of which 4 patients was treated by angioplasty and stent placement. With 16 -31 months follow-up, the patency of portal vein was maintained. Neither server complication nor related-death was occurred. Conclusions Ultra-sound-guided percutaneous portal vein guide wire placement adjuncts thrombolytic catheter is effective and safety for treating portal vein thrombosis after liver transplantation.

关 键 词：超声检查 门静脉/外科学 肝静脐∥外科学 静脉切开术 血栓溶解疗法 静脉血栓栓塞/并发症/外科学 肝移植/副作用 

分 类 号：R657.3[医药卫生—外科学]