Experiments And Clinical Application Study Of Interventional Treatment Of Portal Vein System Thrombosis

Part One:Preparation of Animal Model of Portal Vein System Thrombosis and Interventional TherapyObjective:To prepare portal vein thrombosis animal model and interventional therapy. Materials and Methods:Experiments using a total of nine small pigs, ultrasound-guided percutaneous intrahepatic portal vein and injection of prothrombin, the artificial formation of blood clots.Enhanced CT examination are confirmed for comparison with postoperative. According to the different route of intervention, the experimental animals were divided into three groups:Group A,3 were treated by TIPS pathway; Group B,3 were cured by percutaneous transhepatic catheter-directed thrombolysis and thromboclasis therapy;Group C,3 were processed with thrombolysis therapy transit superior mesenteric artery(SMA). After treatment, all animals were followed up one week to three months and review of CT or ultrasound to understand changes in portal vein blood flow. Results:After treatment, In group A,3 cases of portal vein blood completely recanalization,and enhanced CT examination shows patency of portal vein during 1 month postoperative follow-up;Group B:1 case of portal vein completely recanalization, two cases no further intervention through the portal vein; Group C:After treatment of 3 casea with portal vein were not recanalization. Conclusions:The experimental animals treated in TIPS way by catheter-directed thrombolysis and thromboclasis therapy showed better effective than the other two different interventional ways.Part Two:Clinical Efficacy of Portal Vein System Thrombosis Treated in Three Different Interventional ProceduresObjective:To evaluate the clinical efficacy of portal vein system thrombosis treated in three different interventional ways. Materials and Methods:A contrastive analysis was included of 37 patients with portal vein system thrombosis treated by interventional approch. They were divided into 3 groups according to the different access for portal vein. In group A,13 patients were treated by TIPS pathway; In group B,19 patients were cured by percutaneous transhepatic catheter-directed thrombolysis and thromboclasis therapy; In group C,5 patients were deled with indirect thrombolysis therapy transit superior mesenteric artery(SMA). Results:Compared with group A and B,11 (84%) and 7 (37%) patients got complete PV recanalization after thrombolysis; 1 (8%) and 9 (47%) patients were partially recanalized, respectively. In group C,none of 5 patients recovered blood stream of PV after treatment. The PV patency rates of 1,3,6,12 months follow-up were also distinct discrepancy between group A and B. Conclusions:The patients treated in TIPS way by catheter-directed thrombolysis and thromboclasis therapy showed better effective than the other two different interventional ways.Part Three:Acute and Subacute Portal Vein and Superior Mesenteric Vein Thrombosis Treated in Two Percutaneous Interventional WaysObjective:To assess the efficacy of interventional radiological therapy in the management of acute and subacute portal vein (PV) and superior mesenteric vein(SMV)thrombosis. Materials and Methods:Twenty—eight patients with acute or subacute PV and SMV thrombosis were treated by two different percutaneous interventional radiological therapy. Of all,19 patients were treated through transjugular intrahepatic portosystemic shunt (TIPS) pathway and 9 by treated with percutaneous transhepatic catheter-directed thrombolysis. After treatment, all patients were followed up one week to three months. Results:Of all,24 patients with treatment effect after interventional radiological therapy, with no occurrence of complication. For patients treated by TIPS, the majority of the thrombus in PV and SMV was cleared away. Three patients with no significant clinical improvement. One patient died of abdominal bleeding with percutaneous transhepatic catheter-directed thrombolysis.Conclusions:Interventional therapy through TIPS pathway and percutaneous transhepatic catheter-directed thrombolysis are effective in managing acute and subacute PV and SMV thrombosis.