搅拌溶栓在急性门静脉血栓形成治疗中的应用

Application of agitating thrombolysis technique in the treatment of acute portal vein thrombosis

目的:总结搅拌溶栓技术应用于急性门静脉血栓形成(PVT)治疗的安全性和疗效。方法:急性PVT患者10例(男4例,女6例,年龄32~70岁),首先经颈静脉途径或经皮肝穿刺途径入路行门静脉造影,而后采用搅拌溶栓技术溶解血栓,直至血栓大部分溶解;有门静脉高压者再行经颈静脉肝内门体分流术(TIPS)。术后采用多普勒超声及CTA观察门静脉、肝内分流道通畅情况。结果:10例患者中,经皮肝穿刺途径3例,经颈静脉途径7例;搅拌溶栓后6例血栓完全溶解,4例大部分溶解,术后均未发生肺栓塞。7例行TIPS,1例术后第2天确诊大面积肠坏死,给予广泛切除,术后第9天死于肠瘘;1例于术后12个月出现肝内分流道狭窄,给予球囊扩张成形;余5例TIPS支架无狭窄。结论:搅拌溶栓技术可用于急性PVT的治疗,能一次性完成整体治疗,安全有效。

Aim:To evaluate the safety and efficacy of agitating thrombolysis technique in treatment of acute portal vein thrombosis(PVT).Methods:A total of 10 patients with acute PVT(four males and six females,aged 32-70 years)were underwent portography via a transjugular intrahepatic portosystemic approach or a percutaneous transhepatic route,followed by agitation thrombolysis to resolve the thrombi until most thrombi disappeared.The patients with portal hypertension received transjugular intrahepatic portosystemic shunt(TIPS).The patency of portal vein and TIPS stents were observed after the procedure by Doppler ultrasound and computed tomography angiography.Results:Seven patients underwent transjugular intrahepatic portosystemic approach and 3 patients underwent percutaneous transhepatic route;the thrombi completely disappeared in 6 patients after agitating thrombolysis,and none of these patients developed pulmonary embolism after the procedure.Seven patients received TIPS,1 patient experienced extensive intestinal necrosis on the 2nd day after postoperation,received wide resection,and died of intestinal fistula on postoperative the 9th day after operation;TIPS stent stenosis was observed in 1 patient after 12 months and was treated with balloon angioplasty.None of the remaining patients experienced restenosis of the TIPS stents.Conclusion:Agitation thrombolysis is a safe and feasible technique for acute PVT.