急性和亚急性肠系膜上静脉门静脉血栓的介入治疗.DOCVIP

临床医学论文-急性和亚急性肠系膜上静脉门静脉血栓的介入治疗 ?????????? 作者：宋鹏 王茂强 段峰 王志军 刘凤永 【摘要】? 目的 评价介入技术治疗急性和亚急性肠系膜上静脉(superior mesenteric vein，SMV)门静脉(portal vein，PV)血栓形成的疗效。方法 对21例急性和亚急性SMVPV血栓形成患者进行介入治疗。选择经颈静脉途径经肝穿刺门静脉［即通过经颈静脉肝内门脉系统分流术(transjugular intrahepatic portosystemic shunt approach,TIPS途径)］介入治疗(12例)和经导管肠系膜上动脉(superior mesenteric artery,SMA)溶栓治疗(9例)。结果 治疗成功19例，无严重并发症。11例经TIPS途径治疗的患者于治疗结束时造影显示大部分血栓被清除，门静脉系统有血流通过，临床症状缓解。1例虽然SMVPV恢复血流，但12 d后死于腹腔脓肿、MODS。经导管SMA内溶栓治疗9例，术后症状逐渐改善8例，无效1例。结论 经TIPS途径介入技术和经导管SMA溶栓是治疗急性和亚急性SMVPV血栓形成的有效方法。 【关键词】? 门静脉血栓； 肠系膜上静脉血栓； 溶栓治疗； 介入治疗 　　Interventional radiological technique for acute and subacute superior mesenteric veinportal vein thrombosis ??? 【Abstract】? Objective? To assess the efficacy of interventional radiological therapy in the management of acute and subacute superior mesenteric vein (SMV)portal vein (PV) thrombosis.? Methods? Twentyone patients with acute or subacute SMVPV thrombosis were treated by interventional radiological therapy. Of all, 12 patients were treated through transjugular intrahepatic portosystemic shunt (TIPS) pathway and 9 by transcatheter intrasuperior mesenteric artery (intraSMA) thrombolysis. Results? Nineteen out of 21 patients obtained satisfactory outcome after interventional radiological therapy, with no occurrence of complication. For patients treated by TIPS, the majority of the thrombus in PV and SMV was cleared away, resulting in flow restoration in the mesenteric vein in 11 patients after the procedure with clinical improvement. One patient died of intraabdominal sepsis and multiple organ failure although SMVPV flow was restored. Clinical improvement was seen in 8 out of 9 patients undergone transcatheter intraSMA thrombolysis. Conclusions? Interventional radiological therapy through TIPS pathway and transcatheter intraSMA thrombolysis are effective in managing acute and subacute SMVPV thrombosis. ??? 【Key words】? Portal venous thrombosis;? Mesenteric venous thrombosis;? Thrombolysis;?? Intervention