肝硬化合并门静脉血栓的患者应用纤溶酶溶栓的疗效研究

Clinical efficacy of fibrinolytic enzyme in cirrhosis patients complicated with portal vein thrombosis

目的探讨肝硬化合并门静脉血栓患者应用纤溶酶溶栓的疗效及安全性。方法对应用纤溶酶溶栓治疗的13例肝硬化合并门静脉血栓形成患者,利用影像学CT检查监测门静脉血栓的溶栓情况,观察纤溶酶溶栓的疗效及相关并发症。结果 13例患者中,11例是脾切除术后门静脉血栓形成,1例是自发脾梗死后门静脉血栓形成,1例是脾功能亢进行脾栓塞后门静脉血栓形成。所有患者均无特异临床表现,临床上经腹部增强CT确诊。其中肝功能Child-Pugh分级A级8例,B级5例。所有使用纤溶酶的13例患者,门静脉血栓完全溶解,溶解率100%,门静脉再通100%,其中11例在治疗1个疗程后门静脉血栓完全溶解,2例治疗2个疗程后门静脉血栓完全溶解。溶栓对患者的凝血酶原时间(PT)及肝功能Child-Pugh分级均无明显影响,所有患者临床症状改善且无明显并发症出现。溶栓疗程结束后对所有患者进行随访,9例患者随访时间超过1年,复查未见门静脉血栓再现,无出现消化道出血及大量腹水。结论纤溶酶溶栓效果好且安全,应用纤溶酶溶栓有望成为肝硬化合并门静脉血栓患者的可选治疗方案之一。

Objective To investigate the clinical efficacy and safety of fibrinolytic enzyme in patients with liver cirrhosis complicated with portal vein throlnbosis. Methods Thirteen patients diagnosed with liver cirrhosis complicated with portal vein throlnbosis were treated with fibrinolytie enzylne. The throlnbolytie effect of fibrinolytie enzylne on portal vein throlnbosis was observed by CT scan. Clinical efficacy and related complications of fibrinolytie enzylne throlnbolysis were evaluated. Results Alnong 13 patients, 11 eases suffered ffoln portal vein throlnboals after spleneetolny, 1 due to spontaneous splenic iufaretion and 1 offer splenic elnbolization due to hypersplenisln. All patients had no specific clinical lnanifestations and were clinically eoufirlned by enhanced abdolninal CT scan. Alnong theln, 8 patients were classified as Child-Pugh grade A and 5 eases as Child-Pugh grade B. Alnong 13 patients, portal vein throlnbosis was eolnpletely treated with fibrinolytie enzyme. The dissolution rate was 100% and the reeanalization rate of portal vein was 100%. Alnong theln, 11 patients had eolnplete dissolution of portal vein throlnbosis after one course of treatlnent and two patients following two courses of treatlnent Fibrinolytie enzylne throlnbolysis exerted no significant effect upon prothrolnbin tilne （PT） and liver function （Child-Pugh classification）. Clinical sylnptolns were alleviated and no evident eolnplieations occurred. All patients were followed up after the throlnbolytie therapy. Nine patients were followed up for lnore than one year. No recurrence of portal vein throlnbosis and no gastrointestinal bleeding or a large alnount of aseites occurred. Conclusion Fibrinolytie enzylne throlnbolysis is an effective and safe therapy, which is expected to beeolne one of prolnising therapeutic options for liver cirrhosis patients eolnplieated with portal vein throlnboals.