【摘要】 目的评价经皮经肝门静脉穿刺置管介入溶栓术的安全性和疗效。方法3例患者中,男性2例,女性1例,年龄分别为56岁,62岁,70岁。肝炎肝硬化2例,1例腹痛原因待查(后经手术证实为肠间脓肿)。3例患者均经彩色多普勒和CT检查发现门静脉血栓。3例患者均在B超引导下进行经皮经肝门静脉穿刺,置入5F CobraⅠ型导丝及导管鞘,经导管输注20万单位尿激酶后,继以每日30万单位持续注入,连续3天~5天行溶栓治疗,术后抗凝治疗。结果3例患者经皮经肝门静脉穿刺均一次成功,在置管造影及溶栓过程中均无不良反应;拔管前复查造影显示2例患者门静脉100%再通,1例80%再通;3例患者治疗后临床症状好转,腹水消退,肝功能改善,其中2例肝硬化患者食管静脉曲张程度减轻。1例腹痛原因待查患者溶栓后腹痛减轻但未完全缓解,体温较前下降但未正常,于溶栓后2周行剖腹探查,术中证实右下腹肠间包裹性脓肿,行脓肿切开引流,脓液培养为大肠杆菌,继续抗炎治疗2周后,体温降至正常,腹痛完全缓解。结论经皮经肝门静脉穿刺置管介入溶栓术是治疗门静脉血栓的安全、有效方法。更多还原

【Abstract】 Objective To evaluate efficacy and safety of interventional thrombolysis technique for management of portal vein thrombosis by percutaneou transhepatic portal vein puncture.Methods Three patients(2 men and 1 woman with age of 56-,62- and 70-year old)with portal vein thrombosis were diagnosed with liver cirrhosis(n=2) and unknown abdominal pain(inter-enteric abscess proved by surgery).The 3 patients were all diagnosed with portal vein thrombosis by B-mode ultrasound and CT.They were given the same treatment of percutaneou transhepaticportal vein puncture.The puncture was completed under guidance of B-ultrasound andthe 5F Cobra I catheter was introduced into portal vein.Then,urokinase at dose of 200 000U for the first time and then 300 000U/d were injected to dissolve the thrombus for 3～5 days.Results During the whole processes of therapy,there was no side effect in the 3 patients.Before tuber drawn,the portography showed that the thrombosis completely resolved in two cases and in another one was in 80% resolved.The improvement of clinical conditions,the absorption of ascites,and the improvement of liver function tests were observed in all patients.In addition,the degree of esophageal varices was alleviated in two with cirrhosis.The patient of unknown abdominal pain acquired clinical partial response.This patient was diagnosed of inter-enteric abscess by exploratory laparotomy 2 weeks later,and recovered on antibiotic treatment. Conclusion The interventional thrombolysis technique by percutaneou transhepatic portal vein puncture is effective and safe in the treatment of portal vein thrombosis.更多还原