巨大自发性脾肾分流道栓塞联合抗凝治疗门静脉血栓1例报告

黄菊; 王小泽; 罗薛峰; 杨丽

doi:10.12449/JCH250825

巨大自发性脾肾分流道栓塞联合抗凝治疗门静脉血栓1例报告

DOI: 10.12449/JCH250825

四川大学华西医院消化内科，消化系统肿瘤与肝病研究室，成都 610041

基金项目:

四川大学华西医院“1·3·5”高端人才支持计划 (ZYGD23031)

伦理学声明：本例报告已获得患者家属知情同意。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：黄菊负责病史资料整理及撰写论文；王小泽、罗薛峰负责指导及支持性贡献；杨丽负责审核论文并最后定稿，经费支持。

详细信息

通信作者:
杨丽， yangli_hx@scu.edu.cn （ORCID： 0000-0003-3821-9342）

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出版历程
- 收稿日期: 2024-11-10
- 录用日期: 2025-01-13
- 出版日期: 2025-08-25

Large spontaneous splenorenal shunt embolization combined with anticoagulant therapy in treatment of portal vein thrombosis： A case report

Department of Gastroenterology and Hepatology，Laboratory of Gastrointestinal Cancer and Liver Disease，West China Hospital，Sichuan University，Chengdu 610041，China

Research funding:

The 1·3·5 Project for Disciplines of Excellence of West China Hospital, Sichuan University (ZYGD23031)

More Information

Corresponding author: YANG Li， yangli_hx@scu.edu.cn （ORCID： 0000-0003-3821-9342）

摘要

摘要: 门静脉血栓是肝硬化患者常见且严重的并发症，门静脉血流动力学的改变与门静脉血栓的发生密切相关。合并巨大的自发性脾肾分流时门静脉灌注减少、血流速度减慢，极有可能削弱门静脉血栓的抗凝效果。本文将报道1例通过栓塞自发性脾肾分流道联合抗凝治疗策略，实现了门静脉的完全再通，然而，仍需高质量的临床研究进一步验证和支持这一策略的有效性。
- 门静脉 /
- 静脉血栓形成 /
- 栓塞，治疗性
Abstract: Portal vein thrombosis （PVT） is a common and severe complication in patients with liver cirrhosis， and alterations in portal hemodynamics are closely associated with the development of PVT. The presence of large spontaneous splenorenal shunt （SSRS） may lead to reductions in portal vein perfusion and blood flow velocity， which may compromise the anticoagulant effect on PVT. This article reports the treatment strategies of SSRS embolization combined with anticoagulant therapy that help to achieve complete recanalization of the portal vein； however， high-quality clinical studies are still needed to further validate and support the effectiveness of this strategy.
- Portal Vein /
- Venous Thrombosis /
- Embolization， Therapeutic

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注：抗凝治疗前彩超，肝外门静脉管径约12 mm，管腔内未见异常回声充填，门静脉右支走行区未见明显血流信号。

图 1 抗凝治疗前彩超图像

Figure 1. The doppler ultrasound image before anticoagulant

下载: 全尺寸图片幻灯片

注： a，术前腹部CTA显示门静脉右支完全闭塞，左支和主干狭窄，可见较大的脾肾分流（箭头）；b，血管造影提示巨大的脾肾分流道，栓塞后闭塞；c，术后5个月腹部CTA显示门静脉主干及分支完全再通（箭头），脾肾分流未再显影。

图 2 SSRS栓塞前后CT图像对比

Figure 2. The computed tomography images before and after the embolization of SSRS

下载: 全尺寸图片幻灯片

注： a，单纯抗凝治疗后，肝外门静脉管径约9 mm，管腔内查见弱回声充填，内未见明显血流信号，门静脉左右支管腔显示欠清，走行区未见确切血流信号；b，术后10个月复查，肝外门静脉管径约12 mm，管腔内未见异常回声充填，门静脉左右支走行区可见明显血流信号。

图 3 单纯抗凝治疗后以及术后复查的彩超图像

Figure 3. The doppler ultrasound images after simple anticoagulation therapy， postoperative follow-up

下载: 全尺寸图片幻灯片

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