CAJ | 학술논문

目的回顾性分析通过经皮穿肝辅助建立的肝内门静脉分流道,采用机械性血栓清除联合药物性溶栓的方法治疗非急性、症状性门静脉血栓的安全性及疗效.方法从2006年4月至2012年5月,共对18例门静脉血栓形成患者采用经皮穿肝辅助的方法建立肝内门静脉分流道,然后实施球囊扩张碎栓、经长鞘抽吸血栓、连续灌注尿激酶溶栓治疗.结果 18例患者建立肝内门腔静脉分流的成功率为100％,平均溶栓时间为(65.3±29.5)h,尿激酶平均用量为(2324000±945000)U,平均门腔静脉梯度压由术前的(33.8±4.9)mm Hg降至溶栓结束后的(15.4±2.1)mm Hg,治疗前后比较,t=18.263,P＜0.001,差异有统计学意义,治疗后患者临床症状缓解率达94.4％.1例患者于术后第2天死亡,另2例患者分别于术后第5天及术后当天出现轻度肝性脑病及右侧血性胸腔积液,经对症治疗后缓解.在平均(18.6±17.5)个月的随访期内,1例患者死亡,5例患者分流道闭塞,其余患者分流道通畅,无门静脉血栓相关症状复发.结论通过经皮穿肝辅助建立的肝内门静脉分流道,采用机械性血栓清除联合药物性溶栓的方法,治疗非急性、症状性门静脉血栓形成安全有效.
목적 회고성분석통과경피천간보조건립적간내문정맥분류도,채용궤계성혈전청제연합약물성용전적방법치료비급성、증상성문정맥혈전적안전성급료효.방법 종2006년4월지2012년5월,공대18례문정맥혈전형성환자채용경피천간보조적방법건립간내문정맥분류도,연후실시구낭확장쇄전、경장초추흡혈전、련속관주뇨격매용전치료.결과 18례환자건립간내문강정맥분류적성공솔위100％,평균용전시간위(65.3±29.5)h,뇨격매평균용량위(2324000±945000)U,평균문강정맥제도압유술전적(33.8±4.9)mm Hg강지용전결속후적(15.4±2.1)mm Hg,치료전후비교,t=18.263,P＜0.001,차이유통계학의의,치료후환자림상증상완해솔체94.4％.1례환자우술후제2천사망,령2례환자분별우술후제5천급술후당천출현경도간성뇌병급우측혈성흉강적액,경대증치료후완해.재평균(18.6±17.5)개월적수방기내,1례환자사망,5례환자분류도폐새,기여환자분류도통창,무문정맥혈전상관증상복발.결론 통과경피천간보조건립적간내문정맥분류도,채용궤계성혈전청제연합약물성용전적방법,치료비급성、증상성문정맥혈전형성안전유효.
Objective To retrospectively analyze the safety and efficacy of mechanical thrombectomy combined with pharmacologic thrombolysis to treat non-acute and symptomatic portal vein thrombosis (PVT) using an intrahepatic portosystemic shunt (IPS) assisted by pereutaneous transhepatic approach.Methods From April 2006 to May 2012,18 patients with non-acute and symptomatic PVT were treated with balloon dilation,sheath-directed thrombus aspiration and continuous infusion of urokinase using the IPS assisted by percutaneous transhepatic approach.The significance of differences in the portosystemic gradient measured before and after therapy was assessed by paired samples t-test,and survival analysis was made by the Kaplan-Meier method.Results IPS was successfully created in all patients.The mean duration of the fhrombolytic therapy was 65.3 ± 29.5 h,and the mean concentration ofurokinase used for the thrombolysis was 2 324000 ± 945 000 U.Comparison of the mean portosystemic gradients showed a significant improvement in response to the therapy (before:33.8 ± 4.9 mm Hg vs.after:15.4 ± 2.1 mm Hg; P ＜ 0.001).The overall rate of clinical improvement was 94.4％.One patient died on day 2 post-therapy and another two patients experienced mild hepatic encephalopathy or fight hemothorax,respectively,on day 5 post-therapy,with conservative medical management achieving complete recovery for both.The mean follow-up time was 18.6 ± 17.5 months,during which only one patient died and five others experienced shunt dysfunction; all remaining patients showed maintenance of shunt patency without symptoms of recurrence.Conclusion Mechanical thrombectomy combined with pharmacologic thrombolysis via the IPS assisted by percutaneous transhepatic approach is a safe and effective therapeutic option for patients with non-acute and symptomatic PVT.