A Different Interventional Approach Fo R The Treatment Of Portal Vein Thrombosi S Of Clinical Curative Effect Observation (48 Case Reports)

Objective:To explore the clinical efficacy and safety of the interventional technique treatment for portal vein thrombosis.Methods:A retrospective analysis of patients in our hospital from March 2005 to June 2014 was done. Clinical data was collected from 48 patients who had undergone interventional treatment of portal vein thrombosis. Among them, 16 cases were treated with the percutaneous transhepatic portal vein approach, 15 cases were treated with the superior mesenteric artery (SMA), and 17 cases were treated with percutaneous transhepatic portal vein connect with SMA. The efficacy and postoperative complications were investigated for the three different treatment methods.Results:All patients underwent successful catheter thrombolysis. One patient who received thrombolytics via the percutaneous transhepatic approach suffered cardiac and cerebrovascular complications four hours after thrombolysis and died despite rescue efforts. The efficacy rate of the percutaneous transhepatic approach was 93.75%.37.5%(6/16) patients experienced serious complications.Among the patients in the SMA group, there were 3 who had peritoneal irritation and were occult blood positive 24-48 hours after thrombolytic therapy. Emergency laparotomy was performed and intestinal necrosis was confirmed, and treated by resection of necrotic bowel. Two patients died of abdominal infection and multiple organ failure. One patient was discharged after two weeks. The treatment efficacy rate was 80%, the rate of serious complications was 20%(3/15). For patients who received thrombolytics both via the percutaneous transhepatic portal vein along with the SMA, the treatment efficacy rate was 100%, and the rate of serious complications was 47.1%(8/17). The three different treatments had a statistically different curative effect (X2= 10.408, P=10.408). Patients who had the combination of the percutaneous transhepatic approach along with the SMA approach had a better curative effect than those who solely had the SMA approach (X2=9.008, P=0.011) and those who solely had the percutaneous transhepatic approach (X2=1.137,P=0.566). Follow-up was done on the remaining 45 patients who had survived. The follow-up period was 6-12 months.43 patients had no symptoms of abdominal pain nor abdominal distension. One patient in the SMA approach group was found to have renal vein thrombosis one month after discharge. One other patient in this group had recurrence of portal vein and superior mesenteric vein thrombosis. Both patients returned to the hospital and the thrombus was successfully treated with anticoagulation, antiplatelet, and thrombolytic therapy. Abdominal pain, bloating and other symptoms were not found. There was no recurrence of thrombosis in patients in the percutaneous transhepatic approach group nor those who received the combination of the percutaneous transhepatic approach along with the SMA approach.Conclusion:Interventional technology treatment of portal vein thrombosis is safe and effective. Receiving thrombolytics via the percutaneous transhepatic portal vein in combination with via the SMA has a better curative effect than thrombolytics via a single path.