经门静脉导管-皮下药盒系统溶栓治疗门静脉血栓的临床疗效

Thrombolysis through portal vein port-catheter kit for the treatment of portal vein thrombosis

目的探讨经门静脉导管-皮下药盒系统溶栓治疗门静脉血栓形成的临床疗效及安全性。方法将中山大学附属第三医院2005-2007年肝硬化门静脉高压症患者行脾切除术后门静脉血栓形成的42例分为A、B两组：A组20例，通过门静脉导管-皮下药盒系统溶栓。以尿激酶1000U·kg^-1·h^-1持续注入，维持3～6d血栓溶解后改为低分子肝素100AxaIU／kg，每12小时1次，持续7～10d；B组22例，通过外周静脉溶栓，尿激酶剂量加倍，其他同A组。比较完全溶栓率、有效溶栓率、溶栓时间、远期再复发率、并发症发生率。结果A组血栓完全溶解率为75％，有效溶栓率为90％；B组血栓完全溶解率为41％，有效溶栓率为59％。两组之间血栓完全溶解率、有效溶栓率、溶栓时间和并发症的发生率相比差异均有统计学意义，P〈0．05；两组血栓复发率之间相比差异无统计学意义，P〉0．05。结论经门静脉导管-皮下药盒系统溶栓治疗门静脉血栓是一种有效、安全的溶栓方法。

Objective To evaluate a thrombolytic system of portal vein port-catheter kit （PC） in the treatment of portal vein thrombosis （PVT）. Methods In this study, 42 PVT patients with liver cirrhosis and portal hypertension after spleneetomy from 2005 to 2007 were divided into two groups. In group A （20 eases） thrombolysis was administered through the PC device. Urokinase at the dosage of 1000 U · kg^-1· h^-1 was given for a consecutive 3 -6 days through the PC, and then the therapy was converted to 100 AxaIU/kg of low molecular heparin twice a day for 7 days subcutaneously. In group B, the thrombolysis was performed on 22 patients through peripheral veins. The therapy was same as in group A except for that the urokinase dosage was doubled. The complete thrombolysis rate, the effective thrombolysis rate, the time of thrombolysis, the long-term recurrence rate and the incidence of complication were compared between the two groups. Results The complete thrombolysis rate and the effective thrombolysis rate in group A were 75%, 90% respectively, compared with that of 41% , 59% respectively in group B. The significant differences in the complete thrombolysis rate, the effective thrombolysis rate, the time of thrombolysis and the incidence of complication were found between the two groups, while the thrombolysis recurrence rate had no significant difference between the two groups. Conclusion PC regime is an effective and safe method for the treatment of portal vein thrombosis.