TIPS联合PMT在复杂性门静脉血栓中的应用  

Application of TIPS combined with percutaneous mechanical thrombectomy in complex portal venous thrombosis

作　　者：杨建平[1] 管圣[1] 唐加热克[1] 戈小虎[1] YANG Jianping;GUAN Sheng;Tangjiareke;GE Xiaohu(Deparment of Vascular Surgery,Pepole's Hospital of Xinjiang Uygurs Autonomous Region,Xinjiang.Urumqi,830001,China)

机构地区：[1]新疆维吾尔自治区人民医院,乌鲁木齐830001

出　　处：《新疆医学》2020年第3期277-280,共4页Xinjiang Medical Journal

基　　金：乌鲁木齐市科学技术计划项目(项目编号:Y151310017)。

摘　　要：目的探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunts,TIPS)联合机械性血栓清除(percutaneous mechanical thrombus,PMT)在复杂性门静脉血栓(portal vein thrombosis,PVT)治疗中的有效性和安全性。方法收集2016年8月至2018年5月在本科行TIPS联合PMT治疗的PVT患者资料,共有15例门静脉主干伴肠系膜上静脉血栓(superior mesenteric vein thrombosis,SMVT)患者纳入本研究,均因抗凝治疗效果不佳,腹痛持续存在而接受手术治疗。疗效评估主要包括技术成功率、门静脉通畅程度及腹痛症状缓解情况;安全性评估主要包括术中及围手术期相关并发症。结果 15例患者均成功接受TIPS联合PMT治疗,技术成功率100%;2例因PMT后SMV狭窄程度仍>70%,门静脉支架延续至SMV中段,其余均行标准TIPS治疗;术中造影显示门静脉系统及肝内支架血流通畅;腹痛缓解率93.3%。1例术后开腹探查+肠切术,其余围手术期无不良事件发生。随访中1例再次门静脉血栓,1例死于肝衰竭。结论急性PVT除了一线的抗凝治疗;PMT有助于门静脉的再通,TIPS可降低门静脉压力,有利于维持门静脉血流通畅,降低门静脉高压相关并发症的发生;TIPS联合PMT治疗复杂性PVT早期临床效果令人满意,是一种安全、可行的方法。Objective To investigate the efficacy and safety of transjugular intrahepatic portosystemic shunts(TIPS)combined with percutaneous mechanical thrombectomy in the treatment of complex portal vein thrombosis(PVT). Methods The clinic data of patients being treated with TIPS and percutaneous mechanical thrombectomy and being suffered from acute PVT from August 2016 to May 2018 was collected. In this study, 15 patients with portal vein trunk and superior mesenteric vein thrombosis were given surgical treatment because of poor anticoagulant effect and unrelieve abdominal pain. Efficacy evaluation included technical success rate, primary patency of portal vein and relief of abdominal pain. Safety evaluation included intraoperative and perioperative complications. Results 15 patients were treated with TIPS combined with mechanical thrombectomy surgery successfully, and technical success rate was 100%. Above 70% SMV stenosis still happened in 2 patients after PMT, so the stents were extended to the middle segment of SMV. The other patients were treated with standard TIPS therapy. Angiography showed blood flow in portal vein system and intrahepatic stent were unobstructed. The relief rate of abdominal pain was 93.3%. One case was performed exploratory laparotomy and enterectomy after operation. The other cases had no perioperative adverse effect. During follow-up, one patient was suffered from portal vein thrombosis and one case died of liver failure.Conclusion Acute PVT is a kind of first-line anticoagulation therapy. In addition,PMT contributes to recanalization of portal vein,TIPS can reduce portal vein pressure, which is conducive to maintain fluent blood flow of portal vein and reduce the incidence of complications.TIPS combined with PMT for the treatment of complex PVT is a safe and feasible method, and the early clinical results were satisfying.

关 键 词：门静脉血栓形成 经颈静脉肝内门体分流术 机械性血栓清除 

分 类 号：R654.4[医药卫生—外科学]