Praktiknjo M, Meyer C, Strassburg C P, Trebicka J
Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland.
Internist (Berl). 2017 Jan;58(1):82-89. doi: 10.1007/s00108-016-0120-0.
Recent non-cirrhotic and non-malignant splanchnic vein thrombosis is now defined as extrahepatic portal vein thrombosis with or without involvement of the mesenteric vein according to the Baveno VI consensus from 2015. An early diagnosis is often challenging due to unspecific symptoms with abdominal pain or diarrhea but extremely important because of the potential acute and chronic complications, such as mesenteric ischemia and portal hypertension; therefore, rapid treatment is crucial. We present two cases of severe splanchnic vein thrombosis, which were treated with catheter-directed local thrombolysis and thrombus aspiration. These minimally invasive catheter-directed techniques have recently been successfully used in selected patients. A review of the literature is provided in this article. In summary, the management of splanchnic vein thrombosis must be individually planned for each patient and should be performed at experienced centers, which can provide all therapeutic options. In selected cases with the correct indications transjugular transhepatic catheter-directed local thrombolysis is a safe option with a good outcome.
根据2015年巴韦诺VI共识,近期非肝硬化和非恶性内脏静脉血栓形成现定义为肝外门静脉血栓形成,伴或不伴有肠系膜静脉受累。由于腹痛或腹泻等非特异性症状,早期诊断往往具有挑战性,但由于潜在的急慢性并发症,如肠系膜缺血和门静脉高压,早期诊断极为重要;因此,快速治疗至关重要。我们报告两例严重内脏静脉血栓形成病例,采用导管定向局部溶栓和血栓抽吸治疗。这些微创导管定向技术最近已成功应用于部分患者。本文提供了文献综述。总之,内脏静脉血栓形成的管理必须针对每位患者进行个体化规划,且应在能够提供所有治疗选择的经验丰富的中心进行。在有正确适应证的特定病例中,经颈静脉肝内门体分流术导管定向局部溶栓是一种安全且预后良好的选择。