经皮肝穿刺Angiojet机械血栓清除术治疗急性门静脉血栓形成疗效观察

Therapeutic effect of percutaneous transhepatic Angiojet mechanical thrombectomy in the treatment of acute portal vein thrombosis

目的探讨经皮肝穿刺Angiojet机械血栓清除术治疗急性门静脉血栓形成(PVT)的临床效果。方法选择2015年1月至2019年2月濮阳市油田总医院收治的35例急性PVT患者为研究对象,所有患者行经皮肝穿刺Angiojet机械血栓清除术治疗,观察患者术前、术后门静脉血栓分级、门静脉及肠系膜上静脉血栓直径及肝功能Child-Pugh分级,评价血栓清除效果;所有患者术后随访3个月,观察临床症状改善及并发症发生情况;术后3个月复查CT门静脉造影,观察有无新发血栓形成。结果35例患者均成功完成手术,门静脉血栓清除效果A级23例,B级12例。术前、术后门静脉血栓直径分别为(0.73±0.12)、(0.21±0.07)cm,术前、术后肠系膜上静脉血栓直径分别为(0.43±0.10)、(0.14±0.02)cm,术后门静脉和肠系膜上静脉血栓直径均显著小于术前(t=1.216、1.725,P<0.05)。35例PVT患者术后门静脉血栓分级显著优于术前(χ2=6.342,P<0.05)。35例PVT患者术后第3天肝功能Child-Pugh分级与术前比较差异无统计学意义(χ2=0.708,P>0.05)。35例患者腹胀、腹痛症状术后均得以改善或消失,均未出现感染、肝衰竭、肾衰竭、腹腔出血、肠坏死等并发症,术后3个月复查CT门静脉造影未发现新发血栓形成患者。结论经皮肝穿刺Angiojet机械血栓清除术是一种简单、易行的门静脉血栓治疗方式,具有良好的短期血栓清除效果,但其中、远期效果仍需观察。

Objective To investigate the clinical effect of percutaneous transhepatic Angiojet mechanical thrombectomy in the treatment of acute portal vein thrombosis(PVT).Methods Thirty-five patients with acute PVT admitted to Puyang Oilfield General Hospital from January 2015 to February 2019 were selected as the research objects.All patients were treated with percutaneous transhepatic Angiojet mechanical thrombectomy.The grading of portal vein thrombus,the diameter of portal vein and superior mesenteric vein thrombus and the Child-Pugh classification of liver function were observed before and after operation,so as to evaluate the effect of thrombus clearance.All patients were followed up for 3 months to observe the improvement of clinical symptoms and complications.The patients were reexamined by CT venography of portal vein at 3 months after operation to observe whether there was new thrombosis.Results All the 35 patients were successfully performed with the operation,the removal effects of portal vein thrombus were grade A in 23 cases and grade B in 12 cases.The diameter of portal vein thrombus before and after operation was(0.73±0.12)cm and(0.21±0.07)cm,respectively.The diameter of superior mesenteric vein thrombus before and after operation was(0.43±0.10)cm and(0.14±0.02)cm,respectively.The diameter of portal vein and superior mesenteric vein thrombus after operation was significantly smaller than that before operation(t=1.216,1.725;P<0.05).The grade of portal vein thrombus after operation was significantly better than that before operation in the 35 patients with PVT(χ2=6.342,P<0.05).There was no significant difference in the Child-Pugh classification of liver function before and 3 days after operation in the 35 patients with PVT(χ2=0.708,P>0.05).The symptoms of abdominal distension and abdominal pain in 35 patients were improved or disappeared after operation.There were no complications such as infection,liver failure,renal failure,abdominal hemorrhage,intestinal necrosis and other complications.All patients were reexamined with CT venography at 3 months after operation,and no new thrombosis was found.Conclusion Percutaneous transhepatic Angiojet mechanical thrombectomy is a simple and easy way to treat portal vein thrombus.It has good short-term thrombus clearance effect,but the medium-and long-term therapeutic effect still needs to be observed.