共查询到20条相似文献,搜索用时 15 毫秒
1.
经皮经肝介入门静脉血栓溶栓治疗 总被引:1,自引:0,他引:1
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。 相似文献
2.
《Journal of hepatology》2020,72(1):85-94
- Download : Download high-res image (129KB)
- Download : Download full-size image
3.
The etiology and pathogenesis of portal vein thrombosis are unclear. Portal venous thrombosis presentation differs in cirrhotic and tumor-related versus non-cirrhotic and non-tumoral extrahepatic portal venous obstruction (EHPVO). Non-cirrhotic and non-tumoral EHPVO patients are young and present with well tolerated bleeding.Cirrhosis and tumor-related portal vein thrombosis patients are older and have a grim prognosis. Among the 118 patients with portal vein thrombosis, 15.3% had cirrhosis, 42.4% had liver malignancy (primary or metastatic), 6% had pancreatitis (acute or chronic), 5% had hypercoagulable state and 31.3% had idiopathy,12% had hypercoagulable state in the EHPVO group. 相似文献
4.
Kryssia Isabel Rodríguez-Castro Alessandro Antonello Alberto Ferrarese 《World journal of hepatology》2015,7(14):1818-1827
The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being "auto-anticoagulated", prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications. Although many clinical decisions are still based on traditional coagulation parameters such as prothrombin(PT), PT, and international normalized ratio, it is increasingly recognized that these tests do not adequately predict the risk of bleeding, nor they should guide pre-emptive interventions. Moreover, altered coagulation tests should not be considered as a contraindication to the use of anticoagulation, although this therapeutic or prophylactic approach is not at present routinely undertaken. Gastroesophageal variceal bleeding continues to be one of the most feared and deadly complications of cirrhosis and portal hypertension, but great progresses have been made in prevention and treatment strategies. Other bleeding sites that are frequently part of end-stage liver disease are similar to clinical manifestations of thrombocytopenia, with gum bleeding and epistaxis being very common but fortunately only rarely a cause of life-threatening bleeding. On the contrary, manifestations of coagulation factor deficiencies like soft tissue bleeding and hemartrosis are rare in patients with cirrhosis. As far as thrombotic complications are concerned, portal vein thrombosis is the most common event in patients with cirrhosis, but venous thromboembolism is not infrequent, and results in important morbidity and mortality in patients with cirrhosis, especially those with decompensated disease. Future studies and the more widespread use of point-ofcare tests in evaluating hemostasis will aid the clinician in decision making when facing the patient with bleeding or with thrombotic complications, with both ends of a continuum being potentially fatal. 相似文献
5.
6.
The macroscopic appearance of the liver after primary portal vein thrombosis often mimics cirrhosis, despite the absence of
bridging fibrosis at histology. The purpose of this study was to describe unique morphologic changes of the liver after portal
venous thrombosis. A retrospective review was performed to find patients with portal vein thrombosis and a corresponding noncirrhotic
liver biopsy. The CT appearance of the liver was then evaluated, and the liver was categorized as having either peripheral
or central hepatic atrophy. Of 15 patients included in this study, 12 had peripheral atrophy of the liver, while the remaining
three had central atrophy. We concluded that maintenance of central portal venous blood flow and resultant relative peripheral
atrophy of the liver may account for a distinctive rounded configuration of the liver after acute portal vein thrombosis.
Awareness of this appearance after primary portal vein thrombosis may prevent an erroneous diagnosis of cirrhosis. 相似文献
7.
We report a rare case of portal vein thrombosis (PVT) associated with antiphospholipid syndrome (APS) and hepatitis C virus-related
cirrhosis. A 59-year-old woman with hepatitis C virus (HCV) infection was admitted because of coma. The blood test showed
a typically cirrhosis pattern including an elevated serum ammonia level. Abdominal computed tomography showed liver cirrhosis
and thrombus in the right branch of the portal vein. To elucidate the cause of PVT, antiphospholipid antibodies were examined.
Both IgG anti-cardiolipin antibody (ELISA) and IgG anti-cardiolipin-β2 -glycoprotein I complex antibody (ELISA) were positive.
When PVT is detected in a patient with cirrhosis, it might be necessary to examine antiphospholipid antibodies to clarify
the cause of PVT. 相似文献
8.
目的 探讨脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症患者门静脉血栓(PVT)的预测措施。方法 2017年1月~2019年3月我院肝胆外科诊治的肝硬化并发门脉高压症患者60例,均接受脾切除联合贲门周围血管离断术。术后将患者分成A组和B组。在B组,当出现抗凝指针时给予低分子肝素短期抗凝治疗。使用彩超检查门脉指标和诊断PVT形成。结果 术后,在B组30例患者中有20例(66.7%)接受了短期抗凝治疗;在术后3 w末,超声检查发现PVT患者15例(25.0%),其中A组11例(36.7%),显著高于B组的4例【(13.3%),P<0.05】;血栓形成组门静脉直径为(1.5±0.3)cm,与无血栓形成组比,无显著性差异【(1.4±0.2)cm,P>0.05】,门静脉血流流速为(12.3±1.4)cm/s,显著低于无血栓形成组【(14.5±1.7)cm/s,P<0.05】;血栓形成组血清D-二聚体水平显著高于无血栓形成组(P<0.05);血栓形成组外周血血小板计数为(142.6±58.9)×109/L,显著高于无血栓形成组【(91.4±52.4)×109/L,P<0.05】。结论 在采取脾切除联合贲门周围血管离断术治疗肝硬化并发门脉高压症患者时,需警惕术后PVT的形成。对术后血小板计数急剧升高、血清D-二聚体显著升高和门脉血流减慢的患者应该及时给予抗凝治疗。 相似文献
9.
Ashish Aggarwal Kanika Puri Suthat Liangpunsakul 《World journal of gastroenterology : WJG》2014,20(19):5737-5745
Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic complications.Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research,it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors.Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis[deep vein thrombosis(DVT)and pulmonary embolism(PE)];it has also been associated with progression of liver fibrosis.The use of anticoagulants in cirrhosis patients is a challenging,and often a scary situation.This review summarizes the current literature on the prevalence of venous thrombosis(DVT and PE),risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease. 相似文献
10.
Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis
Do Seon Song Si Hyun Bae Myeong Jun Song Sung Won Lee Hee Yeon Kim Young Joon Lee Jung Suk Oh Ho Jong Chun Hae Giu Lee Jong Young Choi Seung Kew Yoon 《World journal of gastroenterology : WJG》2013,19(29):4679-4688
AIM: To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis. METHODS: Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m 2 epirubicin on day 1, 60 mg/m 2 cisplatin for 2 h on day 2, and 500 mg/m 2 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk. RESULTS: Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD).The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm 3 (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-Ⅱ (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and α-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed. CONCLUSION: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm 3 and good prognostic factors. 相似文献
11.
Guglielmi A Fior F Halmos O Veraldi GF Rossaro L Ruzzenente A Cordiano C 《World journal of gastroenterology : WJG》2005,11(13):2035-2038
AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection. METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter. RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved. CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis. 相似文献
12.
Alfredo Guglielmi Francesca Fior Orsolya Halmos Gian Franco Veraldi Lorenzo Rossaro Andrea Ruzzenente Claudio Cordiano 《World journal of gastroenterology : WJG》2005,(13)
AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection. METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter. RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved. CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis. 相似文献
13.
14.
Gulhan Ertan Sila Ulus Rukiye Kilicarslan Mesut Yilmaz Yahya Paksoy Cengiz Erol 《Arab Journal Of Gastroenterology》2019,20(1):50-52
Hydatid cyst disease is a zoonosis caused by the parasite Echinococcus. It may infest any organ of the body, but it most frequently involves the liver, lungs, and nervous system. Portal vein involvement by hydatid cyst disease is extremely rare with only five cases published in the English literature to our knowledge. We present the ultrasonography (US) and computed tomography (CT) findings of a 77-year-old male with hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis. Colour Doppler US confirmed the lack of blood flow within the portal vein and stigmata of cavernomatosis. CT clearly demonstrated a communication between the multiloculated lesion and the portal vein and the multiple daughter vesicles obstructing the portal vein. The consideration of this complication will make it possible to distinguish this entity from portal vein thrombosis and, thus, the management of the patients with hydatid cyst disease particulary in endemic regions. 相似文献
15.
Sanjeev Kumar Jha Ashish Kumar Barjesh Chander Sharma Shiv Kumar Sarin 《Hepatology International》2009,3(2):384-391
Background Patients with cirrhosis and portal hypertension exhibit a hyperdynamic circulation manifesting as increased cardiac output,
heart rate and plasma volume; and decreased arterial blood pressure, systemic vascular resistance, and pulmonary vascular
resistance. It is believed that these changes are related to both hepatocellular dysfunction and portal hypertension. However,
the role of portal hypertension per se in producing these changes in circulation has not been clear. Extrahepatic portal vein
obstruction (EHPVO), a vascular disorder of the liver characterized by cavernomatous transformation of the main portal vein,
is an excellent model to study the role of portal hypertension per se in producing these changes because there is no hepatic
dysfunction in EHPVO. The main aim of our study was, therefore, to evaluate alterations of systemic and pulmonary vascular
systems in patients with EHPVO and compare them with patients with compensated cirrhosis.
Patients and methods Consecutive patients of EHPVO, 15 years or older, and past variceal bleeders were studied. For comparison, consecutive patients
with compensated cirrhosis and history of variceal bleed, matched for variceal status, and body surface area were included.
The hemodynamic studies included the measurements of cardiac index (by Fick’s oxygen method), and systemic and pulmonary vascular
resistance indices.
Results Fifteen patients of EHPVO and same number of controls (compensated cirrhotics) were included in the study. The baseline parameters
in the two groups were comparable. Both EHPVO patients and cirrhotics had similar values in all the measured systemic and
pulmonary hemodynamic parameters. The median (range) cardiac index in EHPVO was 3.8 (2.3–7.7) l min−1 m−2, whereas it was 4.4 (2.8–8.9) l min−1 m−2 in cirrhosis (P = 0.468). The median (range) systemic vascular resistance index in EHPVO was 1,835 (806–3400) dyne s cm−5 m−2, which was similar to that in cirrhotic patients (1,800 [668–3022], P = 0.520). Similarly, the values of median (range) pulmonary vascular resistance index were comparable in the two groups (71
[42–332] vs. 79 [18–428], P = 0.885). A subgroup analysis was done for 8 patients of EHPVO and 8 age-matched compensated cirrhotic patients, which also revealed similar values of cardiac index, cardiac output, systemic vascular resistance
index, systemic vascular resistance, pulmonary vascular resistance index, and pulmonary vascular resistance in the two groups.
Conclusions EHPVO patients have hyperdynamic circulation manifested by high cardiac index and low systemic and pulmonary vascular resistance
indices. These hemodynamic changes are comparable with compensated cirrhotic patients who have similar grade of portal hypertension.
This suggests a predominant role of portal hypertension per se in the genesis of systemic and pulmonary hemodynamic alterations. 相似文献
16.
Jae Youn Cheong Kee Myung Lee Sung Won Cho Je Hwan Won Jai Keun Kim Hee Jung Wang Ki Baik Hahm Jin Hong Kim 《Hepatology research》2005,32(2):127-133
PURPOSE:: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis has a poor prognosis. This study was undertaken to evaluate the therapeutic effects of intra-arterial infusion chemotherapy in advanced HCC, and tried to identify prognostic factors that could affect survival. METHODS AND MATERIALS:: Between January 1995 and January 2001, a total of 102 patients with advanced HCC with portal vein thrombosis were enrolled and divided into three groups: group 1 (n=24) was managed with only supportive care, group 2 (n=25) received systemic combination chemotherapy and group 3 (n=52) received intra-arterial infusion chemotherapy with 5-fluorouracil+cisplatin via implanted chemoport. RESULTS:: One-year survival rates were 0, 4, 21% and median survivals were 2, 4, 6 months in groups 1, 2, 3, respectively (p=0.003). When we divide group 3 patients into long-term (more than 8 months) or short-term survivors, long-term survivor had significantly low level of serum AST (p=0.032) and alkaline phosphatase (p=0.033). Especially, all female patients (n=9) survived more than 8 months (p=0.000). Other favorable prognostic factors for survival were cirrhosis of Child-Pugh class A (p=0.003), only one major branch involvement of the portal vein by tumor (p=0.005), presence of enhancement of tumor portion in arterial phase of CT scan (p=0.044), presence of enhancement of non-tumor portion in portal phase of CT scan (p=0.029). CONCLUSIONS:: Intra-arterial infusion chemotherapy achieved favorable results in advanced HCC with portal vein thrombosis and showed better survival in selected patients. 相似文献
17.
Thomas Couri Carla Harmath Talia Baker Anjana Pillai 《World journal of hepatology》2019,11(2):234-241
BACKGROUND Portal vein thrombosis(PVT) after liver transplantation(LT) is an uncommon complication with potential for significant morbidity and mortality that transplant providers should be cognizant of.Recognizing subtle changes in postoperative ultrasounds that could herald but do not definitively diagnose PVT is paramount.CASE SUMMARY A 30-year-old female with a history of alcohol-related cirrhosis presented with painless jaundice and received a deceased donor orthotopic liver transplant.On the first two days post-operatively,her liver Doppler ultrasounds showed a patent portal vein,increased hepatic arterial diastolic flows,and reduced hepatic arterial resistive indices.She was asymptomatic with improving labs.On postoperative day three,her resistive indices declined further,and computed tomography of the abdomen revealed a large extra-hepatic PVT.The patient then underwent emergent percutaneous venography with tissue plasminogen activator administration,angioplasty,and stent placement.Aspirin was started to prevent stent thrombosis.Follow-up ultrasounds showed a patent portal vein and improved hepatic arterial resistive indices.Her graft function improved to normal by discharge.Although decreased hepatic artery resistive indices and increased diastolic flows on ultrasound are often associated with hepatic arterial stenosis post-LT,PVT can also cause these findings.CONCLUSION Reduced hepatic arterial resistive indices on ultrasound can signify PVT post-LT,and thrombolysis,angioplasty,and stent placement are efficacious treatments. 相似文献
18.
Massimo Primignani Giulia Tosetti Vincenzo La Mura 《World journal of hepatology》2015,7(29):2906-2912
Portal vein thrombosis(PVT) is a frequent complication in cirrhosis, particularly in advanced stages of the disease. As for general venous thromboembolism, risk factors for PVT are slow blood flow, vessel wall damage and hypercoagulability, all features of advanced cirrhosis. Actually, the old dogma of a hemorrhagic tendency in cirrhosis has been challenged by new laboratory tools and the clinical evidence that venous thrombosis also occurs in cirrhosis. The impaired hepatic synthesis of both pro- and anticoagulants leads to a rebalanced hemostasis, more liable to be tipped towards thrombosis or even bleeding. Conventional anticoagulant drugs(low molecular weight heparin or vitamin K antagonists) may be used in cirrhosis patients with PVT, particularly in those eligible for liver transplantation, to prevent thrombosis progression thus permitting/facilitating liver transplant. However, several doubts exist on the level of anticoagulation achieved as estimated by coagulation tests, on the efficacy of treatment monitoring and on the correct timing for discontinuation in non-transplant candidates, while in transplant candidates there is expert consensus on continuing anticoagulation until transplantation. The recent introduction of direct acting oral anticoagulant drugs(DOACs) in other clinical settings generates much interest on their possible application in patients with cirrhosis and PVT. However, DOACs were not evaluated yet in patients with liver disease and cannot be recommended for the present time. 相似文献
19.
Animal models of portal hypertension 总被引:4,自引:0,他引:4
Abraldes JG Pasarín M García-Pagán JC 《World journal of gastroenterology : WJG》2006,12(41):6577-6584
INTRODUCTIONAs for all pathologic conditions, the use of animal models is of enormous importance for the study of pathophysiological disturbances of portal hypertension, since they allow comprehensive study of questions that cannot be addressed in human s… 相似文献