Gabler R, Barnert J, Bohndorf K, Eberl T, Wienbeck M
III. Medizinische Klinik, Zentralklinikum Augsburg.
Dtsch Med Wochenschr. 1997 Feb 14;122(7):188-92. doi: 10.1055/s-2008-1047595.
A transjugular intrahepatic portosystemic stent shunt (TIPSS) had been implanted to lower the portal hypertension in a 56-year-old man with alcoholic liver cirrhosis and several bleedings from fundal varices. A shunt revision with dilatation became necessary one year later. Recently the patient had gained 8 kg in weight in 3 weeks and his abdomen had become distended. The patient's general condition (height 179 cm, weight 82.9 kg) was clearly reduced. He had marked ascites, the liver was enlarged to 17 cm below the costal margin and the right lung base was dull on percussion.
Abdominal sonography detected marked ascites and liver cirrhosis with splenomegaly. Duplex sonography failed to demonstrate any flow in the shunt, indicating its occlusion.
At retrograde dilatation of the stent a fresh thrombosis was noted in the right branch of the portal vein and a partial one in the main trunk. Recanalization was achieved locally 10 mg and systemically 100 mg recombinant tissue plasminogen activator (r-tPA). Hepatic vein pressure measurements before and after the thrombolysis demonstrated a significantly lower hepatic venous occlusion gradient, and the portal hypertension had been reduced by about 45%. The ascites gradually resolved.
Combined local and systemic thrombolysis was successful in recanalizing portal vein thrombosis after TIPSS.
一名56岁患酒精性肝硬化且曾多次发生胃底静脉曲张出血的男性患者，已植入经颈静脉肝内门体分流术（TIPSS）以降低门静脉高压。一年后，需要对分流道进行扩张修复。最近，该患者在3周内体重增加了8kg，腹部膨隆。患者的一般状况（身高179cm，体重82.9kg）明显下降。他有明显腹水，肝脏下缘增大至肋缘下17cm，右肺底部叩诊呈浊音。
腹部超声检查发现明显腹水及肝硬化伴脾肿大。双功超声检查未显示分流道有任何血流，提示分流道闭塞。
在对支架进行逆行扩张时，发现门静脉右支有新鲜血栓形成，主干有部分血栓形成。局部使用10mg、全身使用100mg重组组织型纤溶酶原激活剂（r-tPA）后实现了再通。溶栓前后的肝静脉压力测量显示肝静脉闭塞梯度显著降低，门静脉高压降低了约45%。腹水逐渐消退。
局部和全身联合溶栓成功使TIPSS后门静脉血栓再通。
