中文摘要：

目的 评估经桡动脉途径留置肠系膜上动脉（SMA）导管溶栓术治疗急性门静脉-肠系膜上静脉血栓的安全性和疗效。方法 解放军总医院2002年12月至2010年12月期间用经桡动脉途径留置SMA导管溶栓术治疗急性门静脉-肠系膜上静脉血栓47例，男34例、女13例，年龄19～65（44±13）岁，均有腹痛、腹胀、恶心、厌食等症状，无肠管坏死及腹膜炎证据，均经CT增强扫描确诊。采用经桡动脉途径留置导管至SMA灌注尿激酶（UK）（25万Iu～50万Iu／次，2次／d，总量1．5万Iu·kg^-1·24h^-1）5～11（7．1±2．5）d，同时给予肝素治疗（10Iu·kg^-1·h^-1），监测活化部分促凝血酶原激酶时间（APTT）、间隔3d及撤出留置SMA导管前均常规行腹部CT增强检查。终止溶栓术的指征：临床症状显著改善或消失，复查CT显示血栓消失或血管再通。出院后口服华法林≥12个月。结果 经桡动脉途径留置选择性SMA插管的成功率为100％。2例于开始溶栓后24h内腹痛腹胀加重、新出现腹膜刺激征，最终转外科探察证实存在小肠坏死。临床有效率占95．7％（45／47）：治疗开始后24h腹痛腹胀减轻占80．9％（38／47）、未加重占17．0％（8／47）；治疗开始后48h所有45例患者症状均有明确改善，结束溶栓前患者腹痛、腹胀消失并有食欲。拔出留置SMA导管前复查CT显示，29例（64．4％）门静脉-肠系膜上静脉（PV-SMV）血栓几乎完全消失，16例（35．6％）的血栓有所吸收、部分血管再通，介入治疗前肠壁水肿、肠系膜水肿等均完全消失。与局部穿刺相关并发症发生率为14．9％（7／47），均为轻度，包括穿刺侧桡动脉搏动消失2例、桡动脉穿刺处微小血肿5例，未影响留置SMA导管治疗。随访时间12～86（48±20）个月，43例（95．6％）腹部症状未再复发。2例（4．4％）分别于出院后6个月、5年复发PV-SMV血栓形成，经再?

英文摘要：

Objective To evaluate the feasibility and efficacy of urokinase infusion therapy via a transradial approach for transcatheter superior mesenteric artery （ SMA ） in patients with acute extensive portal and superior mesenteric venous thrombosis. Methods During a period of 8 years, 47 patients with acute extensive thrombosis of portal vein （ PV ） and superior mesenteric veins （ SMV ） received urokinase infusion therapy by transcatheter selective SMA via radial artery. Their mean age was 44 ± 13 years （range： 19-65）. Through radial sheath, a 5F catheter was placed into SMA and subsequently the infusion of urokinase was given for 5-11 days （ mean ： 7.1 ± 2. 5 ） . Adequate anticoagulation was initiated during treatment, throughout hospitalization and post-discharge. Follow-up contrast-enhanced computed tomography （CT） was performed in each patient every 3 days and before the removal of infusion catheter. Termination of urokinase infusion therapy was decided on the basis of clinical and radiographic findings. Results Technical success was achieved in all patients. Two patients had worsening abdominal pain, developed the signs of peritonitis at 24 hours after interventional treatment and underwent eventual laparotomy with the resection of necrotic bowel. Substantial clinical improvement was observed in 45 （95.7%） of them after the procedure. Minor complications at the radial puncture site were observed in 7 patients （14. 9% ） and infusion therapy continued. Follow-up CT scans at pre-discharge demonstrated a nearly complete disappearance of PV-SMV thrombosis in 29 patients （64. 4% ） and partial recanalization of PV-SMV thrombosis in 16 patients（35.6% ）. They were discharged at 9-20 days （mean： 12±6） post-admission. The mean post-discharge duration of follow-up was 48 ± 20 months. Recurrent episodes of PV and SMV thrombosis were observed in 2 （4.4%）patients at 6 months and 5 years respectively post-discharge and they were treated successfully with urokinase infusion