经皮肝穿刺局部处理门静脉血栓形成短期疗效与安全性分析  

Analysis of the short-term efficacy and safety of percutaneous liver puncture in the local treatment of portal vein thrombosis

作　　者：崔婷 王涛[2] 朱冰 孟明明 柳博文 吕一帆 陈权 吴一凡 张裕 董成宾 刘福全 CUI Ting;WANG Tao;ZHU Bing;MENG Mingming;LIU Bowen;LüYifan;CHEN Quan;WU Yifan;ZHANG Yu;DONG Chengbin;LIU Fuquan(Department of Interventional Therapy,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Interventional Therapy,Yantai Yuhuangding Hospital,Yantai,Shandong Province 264099,China;the Center for the Diagnosis and Treatment of Liver Vascular Diseases,the Fifth Medical Center of the PLA General Hospital,Beijing 100161,China)

机构地区：[1]首都医科大学附属北京世纪坛医院介入治疗科,北京100038 [2]烟台毓璜顶医院介入治疗科,山东烟台264099 [3]解放军总医院第五医学中心肝脏血管疾病诊断与治疗中心,北京100161

出　　处：《实用放射学杂志》2024年第8期1338-1341,共4页Journal of Practical Radiology

摘　　要：目的评价经皮肝穿刺局部处理门静脉血栓形成(PVT)的短期疗效与安全性。方法观察197例PVT患者经皮肝穿刺局部处理前后血栓、血流及实验室检查变化,记录患者并发症、合并症发生情况,并随访至治疗后1年。结果治疗后119例(60.41%)PVT患者门静脉主要血管血栓基本消失,57例(28.93%)血栓显著减少,21例(10.66%)血栓变化较小或增加;146例(74.11%)门静脉主要血管血流通畅,29例(14.72%)血流明显改善,22例(11.17%)无明显改善或堵塞情况加重;平均门静脉压力较治疗前明显降低(P<0.001);凝血酶时间、活化部分凝血酶时间及凝血酶原时间较溶栓前延长(P<0.001),纤维蛋白原较溶栓前减少(P<0.001)。治疗期间,35例(17.77%)患者出现合并症。随访至治疗后1年,196例(99.49%)PVT患者存活,其中141例(71.94%)血栓基本消失,42例(21.43%)血栓稳定(或减少),13例(6.63%)血栓增加。结论经皮肝穿刺局部处理PVT短期效果良好、安全,需要全流程规范化管理。Objective To evaluate the short-term efficacy and safety of percutaneous liver puncture for local management of portal vein thrombosis(PVT).Methods Variations in thrombus,blood flow,and laboratory examination results were observed before and after percutaneous liver puncture in 197 patients with PVT,and the occurrence of comorbidities was recorded and followed up for one year after treatment.Results After treatment,the thrombus in the main portal vein vessels almostly disappeared in 119 patients(60.41%)with PVT,the thrombus had a significant reduction in 57 patients(28.93%),and the thrombus had a smaller change or an increase in 21 patients(10.66%);146 patients(74.11%)had smooth blood flow in the main portal vein vessels,29 patients(14.72%)showed significant improvement in blood flow,and 22 patients(11.17%)showed no significant improvement or worsening of blockage.The mean portal venous pressure was significantly lower than that before treatment(P<0.001);thrombin time,activated partial thromboplastin time,and prothrombin time were prolonged compared to those before thrombolysis(P<0.001),and fibrinogen were reduced compared to those before thrombolysis(P<0.001).A total of 35 patients(17.77%)occured comorbidities during treatment.One year after treatment,196 patients(99.49%)with PVT survived,of which thrombus essentially disappeared in 141(71.94%),thrombus stabilized(or decreased)in 42(21.43%),and thrombus increased in 13(6.63%).Conclusion percutaneous liver puncture for local management of PVT is effective and reliable in the short-term and requires standardized management of the entire process.

关 键 词：静脉血栓 门静脉 经皮肝穿刺 溶栓治疗 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]