Mann O, Haag K, Hauenstein K H, Rössle M, Pausch J
Medizinische Klinik I, Städtische Kliniken Kassel.
Dtsch Med Wochenschr. 1995 Sep 8;120(36):1201-6. doi: 10.1055/s-2008-1055466.
A 68-year-old man, without any preceding hepatic or abdominal disease, suddenly developed a severe septic illness with consumptive coagulopathy and upper abdominal pain. B-mode and duplex ultrasonography revealed fresh portal vein thrombosis. Despite extensive conservative measures there was no significant improvement after one week and further thrombus extension with threatened acute mesenteric vein occlusion.
Local fibrinolysis with recombinant plasminogen activator and urokinase via percutaneous transjugular intrahepatic catheterization of the portal vein achieved almost complete dissolution of the thrombus within 3 days. Subsequently the portal vein catheter was changed into a transjugular portosystemic stent shunt (TIPS).
While local or systemic fibrinolysis has been practised in previously reported cases of acute portal vein thrombosis, the described use of TIPS introduces a new element. The shunt between hepatic and portal veins assures therapeutic access to the portal venous bed. It lowers portal vein pressure and can diminish the danger of recurrent thrombosis by raising portal flow. This minimally invasive procedure may be a nearly ideal treatment even in the course of portal vein thrombosis which has a high complication rate.
一名68岁男性，既往无肝脏或腹部疾病史，突然出现严重的败血症性疾病，伴有消耗性凝血病和上腹部疼痛。B超和双功超声检查显示新鲜门静脉血栓形成。尽管采取了广泛的保守治疗措施，但一周后病情无明显改善，血栓进一步扩展，有急性肠系膜静脉闭塞的风险。
通过经皮经颈肝内门静脉置管，使用重组纤溶酶原激活剂和尿激酶进行局部纤溶治疗，在3天内几乎完全溶解了血栓。随后，将门静脉导管改为经颈静脉肝内门体分流术（TIPS）。
虽然在先前报道的急性门静脉血栓形成病例中已采用局部或全身纤溶治疗，但本文所述的TIPS应用引入了一个新的因素。肝静脉与门静脉之间的分流确保了对门静脉床的治疗性通路。它降低了门静脉压力，并可通过增加门静脉血流减少复发血栓形成的危险。即使在并发症发生率很高的门静脉血栓形成过程中，这种微创手术也可能是一种近乎理想的治疗方法。
