经皮肝穿门静脉系统置管溶栓治疗肠系膜上静脉血栓的疗效观察陈俊.DOC

经皮肝穿门静脉系统置管溶栓治疗肠系膜上静脉血栓的疗效观察 陈俊卯 陈建立 赵鹏 王晓涛 王长友 张国志 【摘要】　目的　探讨经皮肝穿直接门静脉-肠系膜上静脉置管溶栓治疗MVT的临床效果。方法　回顾性分析我院2000年1月至2012年4月通过经皮肝穿门静脉置管溶栓对15例MVT患者的治疗情况及疗效。结果　15例患者均成功经皮肝穿门静脉置管，置管后无气胸、胆漏及腹腔内出血。11例患者溶栓效果佳，肠系膜上静脉、门静脉及脾静脉大部分或完全再通，再通率73.3%，死亡率为13.3%，尿激酶总量未超过500万U，未出现全身各系统出血病例，随访6个月-36个月，无门静脉系统血栓加重和复发病例出现。结论　经皮经肝穿刺门静脉系统置管溶栓技术容易掌握，局部灌注溶栓治疗效果佳，并发症发生率低，可作为MVT治疗的一种选择方法。 【关键词】　肠系膜上静脉，血栓形成；经皮肝穿刺门静脉置管，溶栓；介入治疗 Treatment of Mesenteric Vein Thrombosis by Percutaneous Transhepatic Portal Vein Thrombolysis. CHEN Jun-mao,CHEN Jian-li,ZHAO Peng, WANG Xiao-tao,WANG Chang-you, ZHANG Guo-zhi.  【Abstract】Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 15 cases of mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under DSA guidance from January 2000 to April 2011 were analyzed. Results 15 patients were successfully percutaneous transhepatic portal vein catheterization, no pneumothorax after catheter, bile leakage and intra-abdominal hemorrhage. Thrombolytic good effect in 11 patients, superior mesenteric vein, portal vein and splenic vein or complete recanalization of the majority, and then pass rate was 73.3%, total mortality was 13.3%, not more than 500 million U total urokinase, the body does not appear system bleeding patients were followed up for 6 months -36 months, increased portal vein system thrombosis and recurrent cases of the disease. Conclusion Percutaneous transhepatic portal vein catheter thrombolysis techniques easy to master, good effect of local infusion thrombolytic therapy, complication rate, superior mesenteric vein thrombosis can be treated as a selection method.  【Key words】mesen-teric vein thrombosis; percutaneous portal vein catheterization, thrombolytic; intervention therapy 　　肠系膜上静脉血栓(mesen-teric vein thrombosis，MVT) 起病隐匿，临床症状与体征不典型，易被临床忽视，可导致缺血性肠梗阻，病情凶