经腹直视肠系膜上静脉入路AngioJet联合球囊扩张治疗急性门静脉血栓的临床研究

AngioJet thrombectomy combined with balloon dilation via a direct transabdominal superior mesenteric vein approach for acute portal venous system thrombosis

摘要:

背景与目的 急性门静脉血栓形成可导致肠坏死、消化道大出血等严重并发症，单纯抗凝治疗的血栓再通率有限。本文总结经腹小切口直视下穿刺肠系膜上静脉，联合AngioJet溶栓吸栓及球囊扩张治疗急性门静脉血栓形成的临床效果与安全性。方法 回顾性分析2023年7月—2024年12月北京大学人民医院收治的10例急性肠系膜上静脉-门静脉血栓形成患者。所有患者均在全麻下经腹正中小切口直视穿刺肠系膜上静脉，应用AngioJet机械溶栓吸栓联合球囊扩张成形治疗。记录术中即刻血栓清除率、围术期并发症及随访期门静脉系统再通情况。结果 10例患者手术时间中位数为140（110~245）min，不含AngioJet系统相关出血的中位术中出血量为80（50~200）mL；AngioJet机械血栓抽吸系统血栓抽吸时间173（138~296）s。术后即刻血栓清除率Ⅲ级7例，Ⅱ级3例，手术技术成功率为100%。围术期并发症包括腹腔出血1例、切口血肿1例，均经处理后好转。所有患者术后腹痛症状明显缓解，无肠坏死、肠梗阻及急性肾功能不全发生。中位随访时间5个月，门静脉系统完全再通5例，部分再通4例，血栓稳定1例，无血栓新发或复发，随访期内无抗凝相关出血及死亡。结论 经腹直视下穿刺肠系膜上静脉，联合AngioJet溶栓吸栓及球囊扩张治疗广泛急性门静脉-肠系膜上静脉血栓形成安全、有效，可迅速恢复门静脉系统血流，缓解症状并避免肠坏死。

Abstract:

Background and Aims Acute portal venous system thrombosis may lead to life-threatening complications such as intestinal necrosis and variceal bleeding, while anticoagulation alone often results in a low recanalization rate. This study evaluated the safety and efficacy of direct transabdominal superior mesenteric vein puncture combined with AngioJet mechanical thrombectomy and balloon angioplasty for acute portal venous system thrombosis.Methods A retrospective analysis was conducted on 10 consecutive patients with acute superior mesenteric vein-portal vein thrombosis treated between July 2023 and December 2024. All patients underwent direct puncture of the superior mesenteric vein through a small midline laparotomy under general anesthesia, followed by AngioJet mechanical thrombectomy and adjunctive balloon angioplasty. Immediate thrombus clearance, perioperative outcomes, and follow-up recanalization were evaluated.Results The median operative time was 140 (110-245) minutes, and the median intraoperative blood loss excluding AngioJet-related hemolysis was 80 (50-200) mL. The median thrombus aspiration time using the AngioJet mechanical thrombectomy system was 173 (138-296) s. Immediate postoperative thrombus clearance was grade Ⅲ in 7 patients and grade Ⅱ in 3 patients, yielding a technical success rate of 100%. Perioperative complications included one case of intraperitoneal bleeding and one wound hematoma. All patients experienced significant relief of abdominal pain, with no intestinal necrosis, bowel obstruction, or acute renal failure. During a median follow-up of 5 months, complete portal venous system recanalization was achieved in 5 patients, partial recanalization in 4 cases, and stable thrombosis in 1 case, with no recurrence, anticoagulation-related bleeding, or mortality.Conclusion Direct transabdominal puncture of the superior mesenteric vein combined with AngioJet thrombectomy and balloon angioplasty is a safe and effective treatment for extensive acute portal venous system thrombosis, enabling rapid restoration of portal flow and prevention of intestinal ischemic complications.