两种介入途径治疗急性、亚急性门静脉及肠系膜上静脉血栓的临床疗效分析

目的：评价介入技术治疗急性和亚急性门静脉（portal vein，PV）及肠系膜上静脉（superior mesenterie vein, SMV）血栓形成的临床疗效。方法：对28例治疗急性和亚急性（发病一周至一月）的PV及SMV血栓患者进行介入治疗。按介入治疗途径不同分为下述两组：选择经颈静脉穿刺门静脉（transjugular intrahepatic portosystemic shunt , TIPS途径）置管溶栓（19例）和经皮穿肝内门脉（percutaneous transhepatic）置管溶栓治疗（9例）。结果：所有患者随访一周至三个月，其中治疗成功24例，临床症状明显改善，无严重并发症。经TIPS途径治疗的患者组中，16例随访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。3例SMV及PV恢复部分血流，但临床症状无明显改善。经皮穿肝内门脉直接置管溶栓治疗组中，6例患者的PV及SMV内血栓大部分清除，血流基本改善，2例患者PV及SMV血流部分好转，临床症状无明显改善，严重并发症1例（术后两天死于腹腔出血）。结论：经TIPS途径介入技术和经皮穿肝内门脉直接置管溶栓治疗是治疗急性和亚急性PV及SMV血栓形成的有效方法，前者的疗效及安全性均好于后者。

Interventional radiological technique for acute and subacute portal vein and superior mesenteric vein thrombosis

Objective： To assess the efficacy of interventional radiological therapy in the management of acute and subacute portal vein （PV） and superior mesenteric vein（SMV）thrombosis. Methods： Twenty--eight patients with acute or subacute PV and SMV throm- bosis were treated by two different percutaneous interventional radiological therapy. Of all, 19 patients were treated through transjugular intrahepatic portosystemic shunt （TIPS） pathway and 9 by treated with percutaneous transhepatic catheter-directed thrombolysis. After treatment, all patients were followed up one week to three months. Results： Of all, 24 patients had improvement effect after interventional radiological therapy, with no occurrence of complication. For patients l~eated by TIPS, the majority of the thrombus in PV and SMV was cleared away. Three patients had no significant clinical improvement. One patient died of abdominal bleeding with percutaneous transhepatic catheter-directed thrombolysis. Conclusions： Interventional therapy through TIPS pathway and percutaneous transhepatic catheter-directed thrombolysis are effective in managing acute and subacute PV and SMV thrombosis. Efficacy and safety of the former are better than the latter.