经颈静脉肝内门体分流术治疗门静脉血栓的疗效分析  

Efficacy of transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis

作　　者：薛耀辉 杨州 肖航 张彬 胡春芳 郝迎学 XUE Yao-hui;YANG Zhou;XIAO Hang;ZHANG Bin;HU Chun-fang;HAO Ying-xue(Department of Vascular Surgery,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院血管外科,重庆400038

出　　处：《局解手术学杂志》2023年第11期948-951,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：陆军军医大学科技创新能力提升专项项目(2021XJS13);陆军军医大学军事后勤科研专项课题;重庆市沙坪坝区决策咨询与管理项目(沙科局发[2022]27号)。

摘　　要：目的 分析经颈静脉肝内门体分流术(TIPS)治疗急性和慢性门静脉血栓(PVT)的安全性和有效性。方法 回顾性分析我院12例行TIPS治疗的PVT患者的临床资料,观察手术成功率、血栓负荷减少程度、门静脉压力变化、门静脉通畅、腹痛腹胀缓解、围术期并发症等情况。结果 12例患者TIPS手术均成功,手术成功率100%;围术期均未发生消化道及腹腔出血、肝性脑病等并发症。1例急性PVT患者置管溶栓后血栓消退明显,未行后续支架治疗;其余11例慢性PVT患者均一期行支架植入及胃冠状静脉栓塞术。术后复查,门静脉系统超声或CT血管成像检查示门静脉主干及TIPS分流支架血流通畅。结论 TIPS治疗急性和慢性PVT安全可行,其可减轻急性PVT患者血栓负荷,避免肝及肠道坏死;对于慢性PVT,TIPS能有效重塑门静脉通路,同时降低门静脉压力,减少门静脉高压引起的消化道出血、腹腔积液等并发症。Objective To explore the safety and efficacy of transjugular intrahepatic portosystemic shunt(TIPS) for the treatment of acute and chronic portal vein thrombosis(PVT).Methods The clinical data of 12 PVT patients undergoing TIPS in our hospital were retrospectively analyzed.The success rate of surgery,the degree of thrombosis burden reduction,the change of portal vein pressure,the patency of portal vein,the relief of abdominal pain and bloating,and perioperative complications were observed.Results Twelve patients had successful TIPS surgery,with a success rate of surgery of 100%.There was no complications such as gastrointestinal and abdominal hemorrhage or hepatic encephalopathy during the perioperative period.One patient with acute PVT underwent significant thrombus resolution after catheter thrombolysis without subsequent stenting therapy;while the remaining 11 patients with chronic PVT all underwent stent implantation and gastric coronary vein embolization.In the postoperative re-examination,ultrasound or CT angiography examination of portal vein system showed the portal vein trunk and TIPS shunt stent had smooth blood flow.Conclusion TIPS is safe and feasible for the treatment of acute and chronic PVT,which can reduce the thrombotic burden and avoid liver and intestinal necrosis in patients with acute PVT.For chronic PVT,TIPS can effectively reshape the portal vein approach,decrease the portal vein pressure,and reduce gastrointestinal hemorrhage,abdominal fluid and other complications caused by portal hypertension.

关 键 词：门静脉血栓 经颈静脉肝内门体分流术 支架植入 并发症 临床疗效 胃冠状静脉栓塞术 

分 类 号：R615[医药卫生—外科学]