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目的 评价经TIPSS途径门静脉及肠系膜上静脉血栓溶栓治疗的安全性和效果。方法 对6例诊断为PV和SMV广泛血栓形成患者进行了经颈静脉途径经肝穿刺门静脉(简称TIPSS途径)介入溶栓治疗。患者主要症状有腹痛、腹胀、厌食等。腹部体检有压痛,均无明确腹肌紧张和反跳痛。B超、增强CT检查和直接PV-SMV造影确诊为本病。溶栓方法:穿刺PV分支成功后插入导管做PV-SMV造影,确定诊断及了解栓塞范围,抽吸及捣碎血栓,间断将尿激酶经多侧孔导管注入PV和SMV清除大部分血栓后,保留多侧孔导管至SMV内持续溶栓3天-13天。术后药物抗凝治疗6个月左右,此间,密切监测出凝血时间及影象学血变化。结果 介入治疗后,大部分血栓被清除,PV和SMV有血流通过,腹痛、腹胀和腹泻症状逐步缓解。经留置于SMV的导管造影显示PV和SMV主干及主要分支血流通畅,3例门静脉肝内少数分支有残留血栓,但无明显症状。随访4个月至3年,除1例死于外科手术并发症外,其余5例健在、无血栓复发证据及上消化道出血发生。结论 经TIPSS途径介入技术溶栓治疗,是治疗急性PV和SMV血栓形成的安全、具有良好的近期及中远期疗效的方法。
Objective To evaluate the safety and efficacy of thrombolytic therapy with portal vein and superior mesenteric vein via TIPSS. Methods Six patients diagnosed with extensive thrombosis of PV and SMV were treated with thrombolysis through the jugular vein (TIPSS) via the jugular vein. The main symptoms of patients with abdominal pain, abdominal distension, anorexia and so on. Abdominal physical examination have tenderness, no clear abdominal muscle tension and rebound tenderness. B ultrasound, enhanced CT examination and direct PV-SMV angiography diagnosed as the disease. Thrombolysis method: After successful PV branch pricking into the catheter to do PV-SMV angiography to determine the diagnosis and understanding of the embolization range, suction and mashing thrombosis, intermittent injection of urokinase through the multi-lateral port catheter PV and SMV most of the thrombosis, Maintaining the multi-lateral port catheter into the SMV sustained thrombolytic 3 days -13 days. After anticoagulant therapy for 6 months or so, during this time, coagulation time and imaging blood changes were closely monitored. Results After interventional therapy, most thrombi were cleared, PV and SMV had blood flow, and symptoms of abdominal pain, bloating and diarrhea gradually eased. After indwelling catheterization in SMV showed PV and SMV trunk and the main branch of the blood flow, a few branches of the portal vein residual thrombus in 3 cases, but no obvious symptoms. All the patients were followed up for 4 months to 3 years. Except for 1 case died of surgical complications, the remaining 5 cases were alive without evidence of thrombus recurrence and upper gastrointestinal bleeding. Conclusions TIPSS-mediated thrombolytic therapy is a safe and effective method for the treatment of acute PV and SMV thrombosis with good short-term and long-term therapeutic efficacy.