AngioJet血栓抽吸联合经颈静脉肝内门体分流术治疗急性门静脉系统血栓形成效果分析  

AngioJet thrombus aspiration combined with TIPS for the treatment of acute portal venous systemic thrombosis:analysis of curative effect

作　　者：宋德洋 李卫校[1] 徐如涛 崔明哲 翟水亭[1] SONG Deyang;LI Weixiao;XU Rutao;CUI Mingzhe;ZHAI Shuiting(Department of Vascular Surgery,Henan Provincial People’s Hospital,Zhengzhou,Henan Province 450003,China)

机构地区：[1]河南省人民医院血管外科,郑州450003

出　　处：《介入放射学杂志》2022年第3期236-241,共6页Journal of Interventional Radiology

基　　金：河南省科技攻关计划项目(182102310150)。

摘　　要：目的评价AngioJet血栓抽吸联合经颈静脉肝内门体分流术(TIPS)治疗急性门静脉系统血栓形成(APVST)的安全性和有效性。方法回顾性分析2018年1月至2019年12月在河南省人民医院接受AngioJet血栓抽吸联合TIPS治疗的15例APVST患者临床资料。观察住院及术后随访期间患者症状、DSA、CT、血液检查等相关数据变化,评估手术效果。结果15例患者手术均获成功。出院前临床症状均有缓解或消失,出院时支架管腔和肠系膜上静脉完全再通7例,部分再通8例。随访时间为(11.7±5.8)个月,1例术后2个月因拒绝再次手术死于肝衰竭,1例术后28个月再发血栓形成,球囊扩张和支架植入治疗好转后出院,2例出现肝性脑病。术后6个月完全再通9例,部分再通5例。所有生存患者均未发生肠坏死、穿孔及消化道大出血等门静脉高压相关并发症。结论AngioJet血栓抽吸联合TIPS术治疗APVST安全有效,可快速降低门静脉系统血栓量、恢复正向血流,尽早实现门静脉系统再通,降低门静脉海绵样变性及门静脉高压相关并发症发生率。Objective To evaluate the safety and efficacy of AngioJet thrombus aspiration combined with transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of acute portal venous systemic thrombosis(APVST).Methods The clinical data of 15 patients with APVST,who received Angiojet thrombus aspiration combined with TIPS at Henan Provincial People’s Hospital of China between January 2018 and December 2019,were retrospectively analyzed.The changes in clinical symptoms,DSA manifestations,CT findings,blood testing and other relevant data during hospitalization time and postoperative follow-up period were recorded,and the surgical effect was evaluated.Results Successful operation was accomplished in all the15 patients.Before discharge,the clinical symptoms were improved or disappeared.At the time of discharge,complete recanalization of stent lumen and superior mesenteric vein(SMV)was achieved in 7 patients and partial recanalization in 8 patients.The mean follow-up time was(11.7±5.8)months.Two months after the initial operation,one patient refused to take surgery again and died of hepatic failure.One patient developed recurrence of thrombosis twenty-eight months after treatment,which was improved after balloon dilatation and stent implantation.Hepatic encephalopathy occurred in 2 patients.Six months after treatment,complete recanalization was obtained in 9 patients and partial recanalization in 5 patients.No portal hypertension-related complications,such as intestinal necrosis,perforation and massive gastrointestinal bleeding,occurred in all the survival patients.Conclusion For the treatment of APVST,Angiojet thrombus aspiration combined with TIPS is clinically safe and effective.It can rapidly decrease the volume of thrombosis in the portal vein system,restore the forward blood flow,obtain the portal vein system recanalization as soon as possible,and reduce the occurrence of portal vein cavernous degeneration and portal hypertension-related complications.(J Intervent Radiol,2022,31:236-241)

关 键 词：经颈静脉肝内门体分流术 经皮机械取栓术 AngioJet血栓抽吸 急性门静脉系统血栓形成 

分 类 号：R654.4[医药卫生—外科学]