门静脉系统血栓的介入治疗

Interventional treatment of portal vein thrombosis

随着门静脉系统血栓(PVT)的确诊率不断提高,针对PVT的介入治疗也日益受到重视。机械性碎栓及药物性溶栓配合全身性抗凝治疗能部分甚至完全地逆转门静脉血栓后的局部及全身性血流动力学改变,恢复门静脉血流,降低门静脉压力。介入治疗PVT需根据不同情况选择合适的治疗方法及途径。经肠系膜上动脉途径创伤及风险相对较小,但对亚急性、慢性血栓或侧支已形成的单纯门静脉主干血栓溶栓效果多不理想。经门静脉途径是目前最常用的介入治疗手段,包括经皮穿肝、经皮穿脾和经肠系膜静脉等多种入路。经颈静脉肝内门体分流术治疗可为门静脉系统提供一个低阻力的流出道,降低门静脉压力、改善门静脉血流瘀滞。PVT的介入治疗是多手段多途径联合的综合介入治疗。根据病情分别或联合应用多种治疗途径及多种治疗手段能取得更好疗效并降低并发症和病死率。

With the increase in the diagnosis rate of portal vein thrombosis（ PVT）,the interventional treatment for PVT has attracted more and more attention. Mechanical thrombolysis and drug thrombolysis combined with systemic anticoagulant treatment can partly or even completely reverse the local and systemic hemodynamic changes after PVT,restore portal venous flow,and reduce portal venous pressure. The methods and approaches for interventional treatment should be selected based on patients＇ conditions. The superior mesenteric artery approach has a relatively low risk,but it does not have a satisfactory thrombolytic effect in subacute/chronic PVT or PVT in the main portal vein with collateral formation. The portal vein approach is the most commonly used method for interventional treatment at present,including the percutaneous transhepatic approach,the percutaneous trans-splenic approach,and the mesenteric vein approach. Transjugular intrahepatic portosystemic shunt can provide a low-resistance outlet for the portal system and thus reduce portal venous pressure and improve blood stream stasis in the portal vein. The interventional treatment of PVT is a comprehensive interventional therapy that combines multiple methods and approaches. These methods and approaches used alone or in combination based on patients＇ conditions can achieve a good clinical effect and reduce complications and mortality.