TIPS联合导管接触溶栓与经皮经肝门静脉穿刺置管溶栓治疗急性非肝硬化非肿瘤性门静脉血栓  

TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis for acute non-cirrhotic non-neoplastic portal vein thrombosis

作　　者：季杰 吴必飞 闫乐乐 吕朋华 周卫忠[2] 王福安 JI Jie;WU Bifei;YAN Lele;LYU Penghua;ZHOU Weizhong;WANG Fu’an(Department of Interventional Radiology,Northern Jiangsu People’s Hospital,Yangzhou 225001,China;Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]苏北人民医院介入放射科,江苏扬州225001 [2]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《中国介入影像与治疗学》2024年第10期583-587,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的对比TIPS联合导管接触溶栓与经皮经肝门静脉穿刺(肝穿)置管溶栓治疗急性非肝硬化非肿瘤性门静脉血栓(PVT)的价值。方法回顾性纳入25例急性非肝硬化非肿瘤性PVT患者,根据溶栓治疗途径分为TIPS组(n=17,接受TIPS联合导管接触溶栓)与肝穿组(n=8,接受经皮肝穿置管溶栓),记录技术成功率、置管溶栓时长,7天内并发症、3个月门静脉通畅情况、肝功能Child-Pugh分级及肝性脑病(HE)情况并进行组间比较。结果2组技术成功率均为100%;组间置管溶栓时长差异无统计学意义(P>0.05)。TIPS组溶栓效果优于肝穿组(P<0.05)。治疗后7天内组间出血发生率差异无统计学意义(P>0.05)。随访3个月,TIPS组门静脉通畅程度高于肝穿组(P<0.05);组间肝功能Child-Pugh分级结果及HE发生率差异均无统计学意义(P均>0.05)。结论TIPS联合导管接触溶栓及经皮肝穿置管溶栓均为治疗急性非肝硬化非肿瘤性PVT的有效途径,而前者溶栓效果优于后者。Objective To comparatively observe the value of TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis for acute non-cirrhotic non-neoplastic portal vein thrombosis(PVT).Methods Twenty-five patients with acute non-cirrhotic non-neoplastic PVT were retrospectively enrolled and clustered into TIPS group(n=17,underwent TIPS combined with catheter-directed thrombolysis)and liver puncture group(n=8,underwent percutaneous transhepatic portal vein catheterization thrombolysis)according to the access of thrombolysis.The technical success rate,duration of catheter-directed thrombolysis,complications within 7 days,as well as portal vein patency 3 months after treatment,Child-Pugh grading of liver function and occurrence of hepatic encephalopathy(HE)were recorded and compared between groups.Results The technical success rates were both 100%in 2 groups.There was no significant difference of the duration of catheter-directed thrombolysis between groups(P>0.05).The thrombolytic effect in TIPS group was better than that in liver puncture group(P<0.05).No significant difference of the occurrence of bleeding within 7 days was found between groups(P>0.05).After 3 months’follow-up,the degree of portal vein patency in TIPS group was higher than that in liver puncture group(P<0.05).No significant difference of Child-Pugh grading of liver function nor occurrence of HE was found between groups(both P>0.05).Conclusion Both TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis were effective for treating acute non-cirrhotic non-neoplastic PVT,and the thrombolytic effect of the former was better than the latter.

关 键 词：静脉血栓形成 溶栓疗法 门体分流术 经颈静脉肝内 导管 留置 

分 类 号：R364.15[医药卫生—病理学] R815[医药卫生—基础医学]