人工血栓抽吸联合置管溶栓在急性非肝硬化性门静脉血栓治疗中的应用  

Manual aspiration thrombectomy combined with catheter-directed thrombolysis in the treatment of acute non-cirrhotic portal vein thrombosis

作　　者：朱洪江 赵鹏鹏 颜峰 屈长征 符延波 ZHU Hongjiang;ZHAO Pengpeng;YAN Feng;QU Changzheng;FU Yanbo(Department of Vascular Interventional Surgery,Zhangjiajie People’s Hospital,Zhangjiajie,Hunan 427000,China)

机构地区：[1]张家界市人民医院血管介入外科,湖南张家界427000

出　　处：《肝胆胰外科杂志》2023年第10期586-589,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨人工血栓抽吸联合置管溶栓在急性非肝硬化性门静脉血栓治疗中的临床价值。方法回顾性分析2019年1月至2023年4月张家界市人民医院血管介入外科采用人工血栓抽吸联合置管溶栓的9例急性非肝硬化性门静脉血栓患者的临床资料与影像资料,分析溶栓治疗后血栓的清除程度。结果所有患者均在CT引导下成功穿刺门静脉,均行人工血栓抽吸及置管溶栓治疗。术后即刻造影评估门静脉血栓清除Ⅲ级6例,Ⅱ级3例。治疗后腹痛症状均明显好转。其中1例患者出现肠坏死,切除部分肠管后好转;1例患者在溶栓期间发生穿刺点出血,经输血、穿刺点弹簧圈栓塞止血后恢复;3例患者溶栓过程中出现发热,经抗感染治疗后好转。人工血栓抽吸及置管溶栓治疗后6个月,门静脉系统血栓清除Ⅲ级8例,Ⅱ级1例。腹痛症状均未复发。结论人工血栓抽吸联合置管溶栓治疗急性非肝硬化性门静脉血栓安全、有效。objective To investigate the clinical value of manual aspiration thrombectomy combined with catheter-directed thrombolysis in the treatment of acute non-cirrhotic portal vein thrombosis.Methods A retrospective analysis was conducted on the clinical and imaging data of 9 patients with acute non-cirrhotic portal vein thrombosis who underwent manual aspiration thrombectomy combined with catheter-directed thrombolysis in Zhangjiajie People’s Hospital between Jan.2019 and Apr.2023.The degree of thrombus clearance after thrombolysis was analyzed.Results All the patients underwent portal vein puncture under CT guidance and successfully received manual aspiration thrombectomy and catheter-directed thrombolysis.Immediate post-procedural imaging evaluation showed complete thrombus clearance(GradeⅢ)in 6 cases and partial clearance(GradeⅡ)in 3 cases.The symptoms of abdominal pain significantly improved after treatment.Among them,one patient developed intestinal necrosis,but it improved after partial intestinal resection.Another patient experienced puncture site bleeding during thrombolysis,but this issue was recovered after receiving a blood transfusion and undergoing embolization using a coil to seal the puncture site.Three patients developed fever during the thrombolysis processand improved after anti-infective treatment.After a 6 month follow-up period,complete thrombus clearance(GradeⅢ)was found in 8 cases and partial clearance(GradeⅡ)was found in 1 case.None of the patients experienced a recurrence of abdominal pain symptoms.Conclusion Manual aspiration thrombectomy combined with catheter-directed thrombolysis is safe and effective for treatment of acute non-cirrhotic portal vein thrombosis.

关 键 词：非肝硬化性门静脉血栓 人工血栓抽吸 置管溶栓 介入治疗 

分 类 号：R657.3[医药卫生—外科学]