摘要
目的:评价直接门静脉血栓溶栓术治疗广泛性门静脉系统血栓形成的治疗价值。方法:2004年10月—2006年2月收入院的门静脉系统血栓形成患者12例,其中男性11例,女性1例,平均45.9岁,门静脉合并肠系膜上静脉血栓形成患者8例,同时合并有脾静脉血栓的4例,以持续性中重度上腹痛、腹胀起痛,体检腹部压痛、反跳痛等急腹症体征不明显。所有病例均经增强CT及直接门静脉造影证实诊断。对10例患者采用经皮穿肝途径,2例采用经颈静脉途径(TIPS途径),引入多侧孔导管,侧孔段置于血栓内,首剂在术中于15min内灌注尿激酶25万U,固定导管后返回病房,继续经导管注入尿激酶3～5万U·h^(-1),肝素钠300～780 U·h^(-1),间隔每6～12h经导管行DSA血管造影了解溶栓情况,并适当调整导管位置。治疗期间密切随访患者凝血功能状态,严密观察患者症状体征,适时调整药物剂量。结果:11例患者中死亡2例,其余10例在溶栓24～120h后,门脉血流获得了完全或部分再通.腹痛、腹胀等症状缓解。随访4～12个月10例患者中有2例因再次门脉血栓形成并出现腹痛腹胀等症状而入院,并成功地接受了二次溶栓治疗;其余患者腹痛、腹胀症状消失。结论:直接门脉血栓溶栓术治疗广泛门静脉系统血栓形成安全有效。选择合适的病例、术前全面影像学评估和溶栓过程中严密随访是确保疗效的关键。
Objective： To evaluate the therapeutic value of direct portal vein thrombolysis. Methods： 12 cases of thrombokinesis in portal vein system was treated with the method of direct portal vein thrombolysis. 11 men and 1 women with a median age of 45.9 years （range, 34 65 years） were involved in this group. All cases started whh persistent middle to serious upper abdominal pain or distention. But in physical examination, abdominal tenderness, rebound tenderness is not obvious. All cases were confirmed by enhancive CT scan and direct portal venography. We took the TIPS （transjugular intra hepatic, portal-systemic shunt） route in 2 cases, and the direct transhepatic route in other 10 cases. The side holes segment of the side-holes catheter was inserted into thrombus,25t） thousand unit urokinase wsa infused in 15 minutes, anchored catheter and returned to ward, 30-50 thousand unit urokinase was continued infusing through the catheter. Interval 6 to 12 hours, DSA was carried out to monitor the statue of thrombus, and the position of catheter tip was adjusted properly. During the treatment period, we followed up the patient＇s blood clotting function closely, and adjust the dose of urokinase at the right time. Results： Two cases was died. Portal vein blood flow was complete or partial recanalization, and the abdominal pain or distention was symptomatic relief after 24-120 hours in the rest 10 cases. Conclusion：The interventional radiology method of direct portal vein thrombolysis is safety and efficient. Choosing suitable cases, full-scale imageology evaluation and closely follow-up during thrombolysis can ensure the success of operation.
出处
《中国临床医学》
北大核心
2007年第6期812-814,共3页
Chinese Journal of Clinical Medicine
关键词
门静脉血栓
溶栓治疗
介入
Portal vein thrombus
Thrombolysis
Interventional radiology
