肠系膜静脉血栓的介入治疗

目的探讨经肠系膜上动脉灌注罂粟碱和经皮经肝肠系膜静脉取栓和／或溶栓联合治疗肠系膜静脉血栓（MVT）的价值。方法回顾分析北大三院经介入诊治的9例MVT。9例患者均行血管造影检查和超声检查，其中5例行CT检查，2例行MR检查。患者从就诊到明确诊断接受介入治疗的时间间隔为15～168小时。明确诊断MVT后即经外周静脉给予肝素抗凝治疗；9例MVT均行经肠系膜动脉灌注罂粟碱治疗，其中8例同时行经皮经肝门静脉、肠系膜上静脉取栓和溶栓治疗。2例怀疑肠坏死介入治疗后行外科肠切除术。结果本组9例MVT中2例血栓局限在肠系膜上静脉内；7例血栓延及门静脉或脾静脉。9例患者7例治愈；1例不明原因猝死；1例因门脉高压行门腔静脉分流术后肝功衰竭死亡。结论经肠系膜动脉灌注罂粟碱联合经皮经肝门静脉、肠系膜静脉取栓和／或溶栓是治疗MVT的有效方法。

Interventional therapy of mesenteric venous thrombosis

Objective The aim of this study was to explore the value of mesenteric venous thrombosis(MVT) treated via the superior mesenteric arterial papaverine and thrombolysis and /or thrombolytic percutaneous transhepatic recanalization.Methods A retrospective analysis was carried out of nine MVT patients by interventional diagnosis and therapy in the Beijing university 3rd hospital,they all underwent angiography and ultrasonography,among them five with CT checks and two with MR checks.From medical examination to receiving interventional treatment the time intervals were 15-168 hours.After diagnosis of MVT,they were immediately given peripheral intravenous heparin therapy;they all received mesenteric arterial papaverine treatment,while eight cases of them received percutaneous transhepatic portal vein and Superior mesenteric vein thrombosis and thrombolytic therapy.Two cases of them,who were suspected with intestinal necrosis,are processed the surgical intestinal resection after interventional treatment.Results Nine MVT cases in this group,2 cases' thrombosis were limited in the superior mesenteric vein;7 cases' thrombosis went along the portal vein or the splenic vein.Among all of them,seven cases were cured;one case was dead with unknown causes;one case died of liver failure after the operation of portosystemic shunt trip due to the portal hypertension.Conclusion The most effective way of MVT therapy is via mesenteric arterial papaverine jointly with thrombolysis and/or thrombolytic percutaneous transhepatic portal vein or mesenteric vein.