经TIPS与经皮经肝导管接触溶栓治疗急性门静脉血栓疗效对比

Comparison of transjugular intrahepatic portosystemic shunt and percutaneous transhepatic catheter thrombolysis on acute portal vein thrombosis

目的 比较经颈静脉肝内门体分流术（TIPS）并导管接触溶栓治疗急性门静脉血栓的临床疗效。 方法 选取急性门静脉血栓患者34例，其中经TIPS并导管接触溶栓14例，经皮经肝导管接触溶栓17例，3例手术未能成功。比较两组治疗方案的溶栓时间、溶栓效果、并发症及血栓复发情况。 结果 经TIPS并导管接触溶栓14例，术后平均溶栓时间7.2 d，影像检查见门静脉再通（〉75.0%）患者11例（78.6%），并发症4例（28.6%），随访过程中1例（7.1%）血栓复发。经皮经肝导管接触溶栓17例，术后平均溶栓时间10.1 d，影像检查见门静脉再通6例（35.3%），并发症8例（47.1%），随访过程中7例（41.2%）血栓复发。经TIPS并导管接触溶栓较经皮经肝导管接触溶栓溶栓时间缩短（P＝0.033），门静脉再通率（〉75.0%）高（P＝0.029），血栓复发率低（P＝0.045）。 结论 经TIPS与经皮经肝导管接触溶栓均能有效溶解急性门静脉血栓，且TIPS疗效优于经皮经肝途径。

Objective To compare the efficacy of transjugular intrahepatic portosystemic shunt （TIPS） and percutaneous transhepatic catheter directed thrombolysis（CDT） on acute portal vein throm- bosis（PVT）. Methods The clinical data of 34 patients with acute portal vein thrombosis were analyzed retrospectively. Among them, 14 cases were treated with TIPS and catheter contact thrombolysis, 17 cases received pereutaneous transhepatie catheter thrombolysis, and 3 cases failed to be operated success- fully. The thrombolytic therapeutic time, effect, complications and recurrence of PVT during the follow- up were compared. Results TIPS combined with CDT were successfully created in 14 patients. The mean thrombolytic therapeutic time was 7.2 days, and portal veins were recanalized more than 75.0% by imaging finding in 11 patients （78.6%）. Four patients（28.6% ） had complications. During follow-up, 1 patient （7.1%） had recurrence of thrombus. In the 17 cases treated by percu-taneous transhepatic catheter thrombolysis, the mean postoperative time of thrombolysis was 10. 1 days, portal vein reeanaliza- tion （ 〉75.0% ） examed by X-ray occurred in 6 cases（35.3% ）, 8 cases experienced complications （47.1%）, during the follow-up 7 cases （41.2%） suffered recurrent thrombosis. After TIPS and cathe- ter directed thrombolysis, the thrombolysis time was shortened （ P = 0. 033 ）, the recanalization rate of portal vein （ 〉 75% ） was higher （P = 0. 029）, and the recurrence rate of thrombus was low （P = 0. 045 ）. Conclusions Both the two methods are effecive in the treatment of acute PVT, and TIPS com- bined with CDT may be better.