[1]刘金朝,汪子文,杨思福,等.经皮肝穿刺Angiojet机械血栓清除术治疗急性门静脉血栓形成疗效观察[J].新乡医学院学报,2020,37(8):750-753.[doi:10.7683/xxyxyxb.2020.08.011]
 LIU Jinchao,WANG Ziwen,YANG Sifu,et al.Therapeutic effect of percutaneous transhepatic Angiojet mechanical thrombectomy in the treatment of acute portal vein thrombosis[J].Journal of Xinxiang Medical University,2020,37(8):750-753.[doi:10.7683/xxyxyxb.2020.08.011]
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经皮肝穿刺Angiojet机械血栓清除术治疗急性门静脉血栓形成疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年8
页码:
750-753
栏目:
临床研究
出版日期:
2020-08-05

文章信息/Info

Title:
Therapeutic effect of percutaneous transhepatic Angiojet mechanical thrombectomy in the treatment of acute portal vein thrombosis
作者:
刘金朝汪子文杨思福李红伟陈付文史宏生袁龙涛王 瞻刘宏兵
(濮阳市油田总医院介入科,河南 濮阳 457000)
Author(s):
LIU JinchaoWANG ZiwenYANG SifuLI HongweiCHEN FuwenSHI HongshengYUAN LongtaoWANG ZhanLIU Hongbing
(Department of Interventional Therapy,Puyang Oilfield General Hospital,Puyang 457000,Henan Province,China)
关键词:
门静脉血栓形成Angiojet血栓清除术介入治疗
Keywords:
portal vein thrombosisAngiojetthrombectomyinterventional therapy
分类号:
R657.3
DOI:
10.7683/xxyxyxb.2020.08.011
文献标志码:
A
摘要:
目的 探讨经皮肝穿刺Angiojet机械血栓清除术治疗急性门静脉血栓形成(PVT)的临床效果。方法 选择2015年1月至2019年2月濮阳市油田总医院收治的35例急性PVT患者为研究对象,所有患者行经皮肝穿刺Angiojet机械血栓清除术治疗,观察患者术前、术后门静脉血栓分级、门静脉及肠系膜上静脉血栓直径及肝功能Child-Pugh分级,评价血栓清除效果;所有患者术后随访3个月,观察临床症状改善及并发症发生情况;术后3个月复查CT门静脉造影,观察有无新发血栓形成。结果 35例患者均成功完成手术,门静脉血栓清除效果A级23例,B级12例。术前、术后门静脉血栓直径分别为(0.73±0.12)、(0.21±0.07)cm,术前、术后肠系膜上静脉血栓直径分别为(0.43±0.10)、(0.14±0.02)cm,术后门静脉和肠系膜上静脉血栓直径均显著小于术前(t=1.216、1.725,P<0.05)。35例PVT患者术后门静脉血栓分级显著优于术前(χ2=6.342,P<0.05)。35例PVT患者术后第3天肝功能Child-Pugh分级与术前比较差异无统计学意义(χ2=0.708,P>0.05)。35例患者腹胀、腹痛症状术后均得以改善或消失,均未出现感染、肝衰竭、肾衰竭、腹腔出血、肠坏死等并发症,术后3个月复查CT门静脉造影未发现新发血栓形成患者。结论 经皮肝穿刺Angiojet机械血栓清除术是一种简单、易行的门静脉血栓治疗方式,具有良好的短期血栓清除效果,但其中、远期效果仍需观察。
Abstract:
Objective To investigate the clinical effect of percutaneous transhepatic Angiojet mechanical thrombectomy in the treatment of acute portal vein thrombosis (PVT).Methods Thirty-five patients with acute PVT admitted to Puyang Oilfield General Hospital from January 2015 to February 2019 were selected as the research objects.All patients were treated with percutaneous transhepatic Angiojet mechanical thrombectomy.The grading of portal vein thrombus,the diameter of portal vein and superior mesenteric vein thrombus and the Child-Pugh classification of liver function were observed before and after operation,so as to evaluate the effect of thrombus clearance.All patients were followed up for 3 months to observe the improvement of clinical symptoms and complications.The patients were reexamined by CT venography of portal vein at 3 months after operation to observe whether there was new thrombosis.Results All the 35 patients were successfully performed with the operation,the removal effects of portal vein thrombus were grade A in 23 cases and grade B in 12 cases.The diameter of portal vein thrombus before and after operation was (0.73 ± 0.12) cm and (0.21 ± 0.07) cm,respectively.The diameter of superior mesenteric vein thrombus before and after operation was (0.43 ± 0.10) cm and (0.14 ± 0.02) cm,respectively.The diameter of portal vein and superior mesenteric vein thrombus after operation was significantly smaller than that before operation (t=1.216,1.725;P<0.05).The grade of portal vein thrombus after operation was significantly better than that before operation in the 35 patients with PVT (χ2=6.342,P<0.05).There was no significant difference in the Child-Pugh classification of liver function before and 3 days after operation in the 35 patients with PVT (χ2=0.708,P>0.05).The symptoms of abdominal distension and abdominal pain in 35 patients were improved or disappeared after operation.There were no complications such as infection,liver failure,renal failure,abdominal hemorrhage,intestinal necrosis and other complications.All patients were reexamined with CT venography at 3 months after operation,and no new thrombosis was found.Conclusion Percutaneous transhepatic Angiojet mechanical thrombectomy is a simple and easy way to treat portal vein thrombus.It has good short-term thrombus clearance effect,but the medium- and long-term therapeutic effect still needs to be observed.

参考文献/References:

[1] 刘旭臣.肝硬化患者门静脉血栓形成的相关因素分析[D].青岛:青岛大学,2019.
[2] 赵平,黎涛,谢吉良,等.早期抗凝干预用于经颈静脉肝内门体静脉支架分流术联合PSE治疗肝硬化患者价值探讨[J].实用肝脏病杂志,2020,23(1):82-85.
[3] 王朝阳,段晓怡,李丹,等.TIPS联合搅拌溶栓治疗肝硬化急性门静脉血栓的临床疗效分析[J].中华肝胆外科杂志,2020,26(1):22-26.
[4] 张文广,任建庄,韩新巍,等.经颈静脉肝内门体分流术联合AngioJet血栓清除装置治疗肝硬化急性门静脉广泛血栓效果分析[J].中华医学杂志,2020,100(7):533-537.
[5] 刘娟娟,薛挥.肝硬化门静脉血栓形成的临床诊治进展[J].医学综述,2019,25(2):124-128.
[6] 王柳青.肝硬化患者并发上消化道出血的临床特点及预后影响因素分析[D].唐山:华北理工大学,2019.
[7] 许丹青,杨晋辉.肝硬化门静脉血栓治疗进展[J].中国当代医药,2019,26(5):26-29.
[8] RUSCH R,TRENTMANN J,HUMMITZSCH L,et al.Effectiveness and safety of percutaneous thrombectomy devices:comparison of rotarex and angiojet in a physiological circulation model[J].Eur J Vasc Endovasc Surg,2020,59(6):983-989.
[9] 刘恒,崔明哲,李卫校,等.AngioJet肺动脉血栓清除术中心律失常5例及文献回顾[J].中华血管外科杂志,2020,5(1):49-52.
[10] WANG S S,YU Z H,WANG H T,et al.Angiojet for patients having contraindication of thrombolysis vs CDT for patients having no contraindication of thrombolysis in treating acute LEDVT:comparison of clinical effect[J].J Intervent Radiol,2019,10(16):1425-1426.
[11] 胡晓钢,金红来,鲁军,等.经颈静脉肝内门体分流术治疗门静脉血栓形成伴急性消化道大出血效果评价[J].介入放射学杂志,2018,27(6):516-520.
[12] 朱军,戴真煜,姚立正,等.AngioJet 药物机械偶联血栓清除术治疗急性下肢深静脉血栓形成[J].介入放射学杂志,2017,26(6): 518-521.
[13] YERDEL M A,GUNSON B,MIRZA D,et al.Portal vein thrombosis in adults undergoing liver transplantation:risk factors,screening,management,and outcome[J].Transplantation,2000,69(9):1873-1881.
[14] CYNAMON J,STEIN E G,DYM R J,et al.A new method for aggressive management of deep vein thrombosis:retrospective study of the power pulse technique[J].J Vasc Interv Radiol,2006,17(6):1043-1049.
[15] 袁继丽,刘成海,赵长青.肝硬化Child-Pugh评分的相关因素分析[J].临床肝胆病杂志,2011,27(3):270-272.
[16] 梁刚,王智翔,何盟国,等.早期联合抗凝对脾切断流术后门静脉系统血栓形成的预防效果[J].临床医学研究与实践,2019,4(4):5-6,9.
[17] 张瑞.肝硬化门脉高压症并发血栓形成机制和治疗研究进展[J].实用肝脏病杂志,2019,22(6):930-933.
[18] 王剑锋.经皮肝穿刺门静脉置管溶栓在肝移植术后门静脉血栓性闭塞介入治疗中的应用价值[J].中国医师杂志,2016,18(7):1088-1090.
[19] 王海涛,于志海,涂灿,等.TIPS途径应用AngioJet治疗急性弥漫性门静脉血栓形成9例临床观察[J].介入放射学杂志,2019,28(7):678-681.
[20] 胡利萍,熊静平,努力比亚·阿不都克尤木,等.肝硬化腹腔积液感染并门静脉血栓形成危险因素及其评估模型预测价值[J].中国医药,2019,14(10):1524-1527.

更新日期/Last Update: 2020-08-05