中文摘要：

背景：超声(美国) 指导了锁骨的在上或下文锁骨的块通常为上面的极限外科被使用。这使随机化的研究的目的是比较块表演和发作时间，有效性，不利事件和病人的发生是指导美国的在上的接受锁骨或下文锁骨的块。我们假设了在上锁骨的途径，更表面、更容易设想使用 10 MHz 变换器，将生产一更快并且更广泛的感觉的块。方法：120 个病人被使随机化到二个相等的组：在上锁骨的(S) 和下文锁骨的(I) 。每个病人收到了包含 ropivacaine 的相等的体积的混合物 7.5 mg/ml 和 mepivacaine 有肾上腺素 5 μg/ml 的 20 mg/ml， 0.5 ml/kg 身体重量(最小 30 ml，最大值 50 ml ) 。七根终端神经的感觉分数(0 削尖的麻醉 2 点，痛觉缺失 1 点和疼痛) 被估计每 10 min。当他们在肘下面有有效的外科的块麻醉或五根神经的痛觉缺失时，病人们为外科被宣布准备好了。在块以后的三十分钟，解块的神经被补充。块表演和潜伏时间，外科的有效性，不利事件和病人是接受被记录。结果：显著地，在 I 的更多的病人组织为在块以后的外科 20 和 30 min 准备好了。吝啬的块表演时间在 I 组(NS ) 是在 S 组和 5.0 min 的 5.7 min。块有效性在 I 组是优异的：93% 对 78% 在 S 组(P=0.017 ) 。S 组病人有中部、尺骨的神经，而是腋的神经的更好的块的显著地更差的块。在 10， 20 和 30 min 的感觉分数不是显著地不同的。在 S 组的 32 个病人对在 I 组的九个病人经历了短暂不利事件(P【0.0001 ) 。病人块的接受在两个组是类似的。结论：Infraclavicular 块有更快的发作，更好外科的有效性和更少不利事件。块表演时间和病人是过程的接受在两个组是类似的。

英文摘要：

AIM： To present a series of cases with symptomatic acute extensive portal vein （PV） and superior mesenteric vein （SMV） thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS： A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 years. After access to the portal system via the transjugular approach, pigtail catheter fragmentation of clots, local urokinase injection, and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge. RESULTS： Technical success was achieved in all 6 patients. Clinical improvement was seen in these patients within 12-24 h of the procedure. No complications were observed. The 6 patients were discharged 6-14 d （8 ± 2.5 d） after admission. The mean duration of follow-up after hospital discharge was 40 ± 16.5 mo. Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV, and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION： Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.