经颈静脉肝穿刺门静脉途径门静脉及肠系膜上静脉血栓溶栓治疗6例报告  

Thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway

作　　者：刘迎娣[1] 王茂强[1] 王志强[1] 杨云生[1] 刘风永[1] 程留芳[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《解放军医学杂志》2004年第5期455-457,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的　评价经颈静脉经肝穿刺门静脉 (TIPSS)途径门静脉及肠系膜上静脉血栓溶栓治疗的安全性和治疗效果。方法　对6例诊断为门静脉 (PV)和肠系膜静脉 (SMV)广泛血栓形成的患者进行了经TIPSS途径介入溶栓治疗。患者主要症状有腹痛、腹胀、厌食等。腹部体检有压痛 ,均无明确腹肌紧张和反跳痛。经B超、增强CT检查和直接PV SMV造影确诊为本病。溶栓方法 :穿刺PV分支成功后插入导管做PV SMV造影 ,确定诊断及了解栓塞范围 ,抽吸及捣碎血栓 ,间断将尿激酶经多侧孔导管注入PV和SMV清除大部分血栓后 ,保留多侧孔导管于SMV内持续溶栓 3～ 13天。术后药物抗凝治疗 6个月左右。此间 ,密切监测出凝血时间及影像学变化。结果　介入治疗后 ,大部分血栓被清除 ,PV和SMV有血流通过 ,腹痛、腹胀和腹泻症状逐步缓解。经留置于SMV的导管造影显示 ,PV和SMV主干及主要分支血流通畅 ,3例门静脉的肝内少数分支有残留血栓 ,但无明显症状。随访 4个月至 3年 ,除 1例死于外科手术并发症外 ,其余 5例患者健在 ,无血栓复发证据及上消化道出血发生。结论　经TIPSS途径介入溶栓治疗急性PV和SMV血栓形成是安全有效的 。Objective To evaluate the efficacy and safety of thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic shunt (TIPSS) pathway. All 6 patients presented abdominal pain, distention, and anorexia etc. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT. Control PV-SMV venography was performed after access to the PV branch. As soon as the diagnosis was established the thrombus in the PV and SMV was aspirated and fragmented. After the majority of the clot was cleared away with restoration of blood flow in the main trunk, a 4-French catheter with multiple side-holes was passed into the SMV, and urokinase (UK) was continuously infused for 3 to 13 days. Anticoagulants were given for 6 months therefter. Results The majority of the thrombus in PV and SMV was cleared away resulting in flow restoration in all patients after the procedure. Clinical improvement was seen in 5 patients, characterized by progressive alleviation of abdominal pain, distention, and diarrhea. Prior to removal of the infusion catheter from the SMV, venography revealed a complete resolution of the thrombosis in 3 patients, and residual thrombus in the PV branches in 3 cases without showing clinical symptoms. Follow-up Doppler ultrasound scan performed during 4-36 months after the procedure confirmed patency of the PV and SMV. The symptoms did not recur. Conclusions Through the TIPSS pathway, catheter-directed thrombolysis is safe and effective in the treatment of PV and SMV thrombosis.

关 键 词：血栓 肠系膜静脉 血栓 门静脉 溶栓治疗 TIPSS 

分 类 号：R364[医药卫生—病理学]