急性肠系膜上静脉血栓的动静脉联合导管溶栓治疗

Catheter-directed thrombolysis for acute superior mesenteric venous thrombosis via superior mesenteric vein and artery

目的导管溶栓治疗是急性肠系膜上静脉血栓实现早期血管再通的重要手段,主要有经皮经肝穿刺门静脉或经颈静脉门体分流道直接溶栓及经肠系膜上动脉间接溶栓3种途径。文中评估了肠系膜上动、静脉联合导管溶栓治疗急性肠系膜上静脉广泛血栓的临床疗效及安全性。方法回顾性分析2011年5月至2012年7月解放军普通外科研究所应用肠系膜上动、静脉联合导管溶栓疗法治疗8名急性肠系膜上静脉广泛血栓患者。对患者的一般信息、病史、病因、危险因素、影像资料、治疗过程、并发症及随访资料进行整理和分析,总结肠系膜上动、静脉联合导管溶栓治疗急性肠系膜上静脉广泛血栓的相关经验。结果 8名患者成功完成溶栓导管置入后分别经肠系膜上动、静脉持续给予磺达肝葵钠注射液局部抗凝及尿激酶溶栓,其中动脉注射平均(6.13±0.83)d、静脉注射平均(12.00±2.51)d。8名患者溶栓后症状均得到明显缓解。4名患者溶栓后行二次探查手术并给予损伤控制性外科处理,平均切除肠袢(1.63±0.48)m,术后进入重症监护给予液体复苏及器官功能支持后恢复良好。出院前门静脉造影及增强CT扫描证实血栓完全溶解,平均住院时间(19.25±4.89)d。治疗过程中2例出现脓毒症、2例发生穿刺点轻微出血。所有患者在出院后平均(12.13±0.99)个月的随访中,无血栓复发及其他并发症发生。结论对于急性肠系膜上静脉广泛血栓患者,肠系膜上动、静脉联合导管溶栓治疗可以加快症状缓解及血栓溶解,促进侧支血管形成,积极扭转缺血肠袢,有效避免广泛肠切除引起短肠综合症的发生,促进患者早期康复,有效提高整体生存率。

Objective Transcatheter thrombolysis is an important method for early recanalization of acute superior mesenteric venous thrombosis （SMVT）, which is conducted mainly through percutaneous transhepatic , transjugular intrahepatic, or superior mesen-teric artery approach .This study is to assess the feasibility , effectiveness and safety of catheter-directed thrombolysis via the superior mesenteric vein and artery for acute SMVT . Methods We retrospectively reviewed 8 cases of acute extensive SMVT treated by tran-scatheter thrombolysis via superior mesenteric vein and artery in our institute .We collected and analyzed the general information , case history, etiology, risk factors, imaging characteristics, treatment procedures, complications, and follow-up data of the patients summa-rized the experience in the treatment of acute extensive SMVT by catheter-directed thrombolysis . Results Technical success was a-chieved with substantial symptoms improvement after thrombolytic therapy in all the cases .The local urokinase infusion via the superior mesenteric artery and vein was performed for （6.13 ±0.83） and （12 ±2.51） d.Four patients required delayed localized bowel resection of （1.63 ±0.48） m, with satisfactory recovery after intensive care and organ function support .Contrast-enhanced CT scan and portogra-phy demonstrated complete thrombus resolution in all the patients before discharged after a hospital stay of （19.25 ±4.89） d.Minor bleeding at the puncture site occurred in 2 cases and sepsis developed in another 2 postoperatively .No recurrence and complications were ob-served during the follow-up of （12.13 ±0.99） mo. Conclusion For acute extensive SMVT , catheter-directed thrombolytic therapy via superior mesenteric vein and artery can accelerate thrombus resolution , stimulate collateral vessel development , reverse extensive intestinal is-chemia, avert bowel resection , localize infarcted bowel segment to pre-vent short bowel syndrome , and effectively speed up the recovery and significantly increase the survival rate of the patients .