目的 比较胃冠状静脉栓塞联合TIPS治疗肝硬化门静脉高压伴上消化道出血的临床疗效.方法 选取2016年8月至2018年8月本院收治的肝硬化门静脉高压伴上消化道出血患者100例,随机分为联合治疗组(胃冠状静脉栓塞联合TIPS治疗)和单独治疗组(TIPS单独治疗),每组50例.比较两组PPG、PVP指标水平,肝功能指标及术后情况.结果 治疗后,两组PPG、PVP水平均显著低于治疗前(P<0.05);治疗前后两组AST、ALT、ALB、TBIL水平比较差异无统计学意义;联合治疗组分流道通畅率、生存率均显著高于单独治疗组,食管胃曲张静脉再出血、整体再出血率、肝性脑病发生率均显著低于单独治疗组,差异均有统计学意义(P<0.05).结论 与TIPS单独治疗比较,胃冠状静脉栓塞联合TIPS治疗肝硬化门静脉高压伴上消化道出血效果显著,能有效改善患者肝功能,提升患者生存率,改善患者预后,值得推广.

目的:观察经溶栓导管接触性溶栓医治下肢深静脉血栓形成(DVT)的效果,评估该疗法的有效性.方法:选择2017.4-2018.8入住我院的30例右下肢DVT患者,将溶栓导管直接放置进入静脉血栓内,微泵持续推注尿激酶进行溶栓.利用静脉通畅评分、静脉通畅率以及健患肢周径差指标评价疗效.结果:30例病患经溶栓导管接触性溶栓治疗后,症状均有显著改善,溶栓前后健患侧大腿、消退周径径比较分析,有统计学意义(P<0.01);27例患者治疗前后静脉造影复查统计发现静脉通畅评分为(4.68±2.27)分,低于溶栓前(9.46±2.87)分,有显著性差异(P<0.01);针对经溶栓导管接触性溶栓治疗后静脉依然不通者采用球囊扩张术与支架置入术,治疗后髂静脉管腔通畅、解除了狭窄,未见显著并发症.本组患者随访率为53.33％(16/30);末次随访时健患侧肢体周径差、静脉通畅评分均低于治疗前(P<0.01).结论:经接触性溶栓导管溶栓治疗DVT,疗效确切,安全性高,具有一定推广价值.

[Objective]To investigate the clinical value of thrombelastogram on patients of deep venous throm-bosis (DVT)and DVT combined with pulmonary embolism (PE).[Methods]12 cases of DVT and DVT with PE in the hospital from March 2014 to September 2014 were selected,of which 8 cases were newly diagnosed as DVT patients,and 4 cases as DVT combined with PE.12 healthy subjects with no history of DVT nor PE were selected as control group,who underwent venous ultrasonography,CT pulmonary angiography (CTA)and Thrombelasto-gram examination.Thrombelastogram index related with DVT and DVT with PE such as blood coagulation time (R),coagulation time (K),maximum blood clot strength (MA),angle,blood coagulation indicators were com-pared with.[Results]There was no statistical significant difference between the DVT group,the DVT combined with PE group and the control group in age,gender,R,MA,K,Angel and CL (P >0.05).[Conclusion]Deep venous thrombosis and deep venous thrombosis combined with pulmonary embolism had no obvious difference in the Thrombelastogram index ,the application value of Thrombelastogram in VTE needs to be further studied.