经颈静脉肝内门体分流术途径AngioJet机械血栓清除手术治疗急性肠系膜上静脉血栓形成的有效性

Effectiveness of AngioJet mechanical thrombectomy via transjugular intrahepatic portosystemic shunt in the treatment of acute superior mesenteric vein thrombosis

目的评估经颈静脉肝内门体分流术(TIPS)途径AngioJet机械血栓清除手术治疗急性肠系膜上静脉血栓形成(SMVT)的安全性和有效性。方法收集2018年1月至2020年9月年甘肃省人民医院收治的19例经TIPS途径AngioJet机械血栓清除手术治疗急性SMVT患者的临床资料。比较肠系膜上静脉(SMV)血栓的分级和通畅状态、门静脉血栓和脾静脉血栓的通畅状态、手术相关并发症发生情况和生存情况等。观察全部患者出院后3、6、12个月的随访结果。结果19例急性SMVT患者均取得技术成功。出院时,SMVT血栓1级9例,2级3例,3级1例,SMVT血栓分级情况较出院前明显改善,差异有统计学意义(P<0.01);出院时,门静脉血栓形成(PVT)患者5例,较出院前明显减少,差异有统计学意义(P=0.009)。出院后3、6、12个月的SMV通畅状态比较,差异无统计学意义(P>0.05)。对全部患者随访12个月,总生存率为94.7%(18/19)。2例患者于住院期间进行了部分肠切除术。1例患者术后4个月时出现大量腹腔积液、自发性腹膜炎、胸腔积液、重度贫血、发烧、肺部感染再次入院,后随访得知患者死亡。结论经TIPS途径行AngioJet机械血栓清除手术治疗急性SMVT是安全有效的。

Objective To evaluate the safety and effect of AngioJet mechanical thrombectomy via transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of acute superior mesenteric vein thrombosis(SMVT).Method The clinical data of 19 patients with acute SMVT treated by AngioJet mechanical thrombectomy via TIPS from January 2018 to September 2020 were collected in Gansu Provincial People's Hospital.The classification and patency status of superior mesenteric vein(SMV)thrombosis,the patency status of portal vein thrombosis and splenic vein thrombosis,the occurrence of surgery-related complications,and postoperative survival were compared.The follow-up results of all patients at 3,6,and 12 months after discharge were also observed.Result All of the 19 patients with acute SMVT achieved technical success.When discharged,there were 9 cases of SMVT thrombus at grade 1,3 at grade 2,and 1 case at grade 3.SMVT thrombus grading was significantly improved compared with themselves before discharge,and the difference was statistically significant(P<0.01).When discharged,there were 5 cases suffering portal vein thrombosis(PVT),and the number was significantly reduced than before discharge,and the difference was statistically significant(P=0.009).There was no statistically significant difference in SMV patency status at 3,6,and 12 months after discharge(P>0.05).All patients were followed up for 12 months,and the overall survival was 94.7%(18/19).Two patients underwent partial bowel resection during hospitalization.One patient had a large amount of abdominal effusion,spontaneous peritonitis,pleural effusion,severe anemia,fever,and lung infection 4 months after the surgery and was re-admitted to the hospital for his disorder.The patient was found dead after follow-up.Conclusion It is safe and effective to treat acute SMVT by the employment of the AngioJet thrombectomy system via TIPS.