Budd-Chiari综合征介入治疗138例分析  

Interventional therapy for Budd-Chiari syndrome: Analysis of 138 cases

作　　者：吴清海[1] 姜同柏[1] 宋涛[1] 孙运粉[1] 王学庆[1] 

机构地区：[1]山东省临沂市人民医院血管外科,临沂276003

出　　处：《中国微创外科杂志》2005年第4期305-306,315,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨不同类型Budd-Chiari综合征(Budd-Chiari syndrome, BCS)介入治疗的选择和疗效. 方法 138例BCS根据下腔静脉(inferior vena cava,IVC)和肝静脉造影分为4种主要类型(I型,IVC膜性狭窄、闭塞;Ⅱ型,IVC节段性狭窄;Ⅲ型,IVC节段性闭塞;Ⅳ型,IVC基本通畅)和9种亚型.治疗方法:经股静脉、右颈静脉或锁骨下静脉进行下腔静脉球囊扩张成形术(percutaneous transluminal angioplasty,PTA)和支架放置术;经皮经肝、经右颈静脉或下腔静脉行肝静脉PTA和支架放置术. 结果 I型成功率100%(83/83),Ⅱ型成功率75.0%(9/12),Ⅲ型成功率81.6%(31/38),Ⅳ型成功率60.0%(3/5).死亡1例(0.7%,1/138).并发症4例(2.9%,4/138),其中误穿心包2例,支架脱落1例,肝脏出血1例.治疗成功的126例随访3～96个月,平均26个月.复发8例,其中2例死亡;肝癌死亡2例. 结论介入治疗BCS创伤小,操作简单,相对安全,疗效满意,成为首选的治疗方法.Objective To investigate the selection and effectiveness of interventional treatment for different types of Budd-Chiari syndrome (BCS). Methods A total of 138 cases of BCS were divided into 4 types (type Ⅰ, membranous stenosis and obstruction of the inferior vena cava; type Ⅱ, segmental stenosis of the inferior vena cava; type Ⅲ, segmental obstruction of the inferior vena cava; type Ⅳ, patent inferior vena cava) and 9 subtypes according to results of angiography of the hepatic vein or the inferior vena cava. Therapeutic methods included percutaneous transluminal angioplasty (PTA) of the inferior vena cava and stent placement by way of the femoral vein, right cervical vein or subclavian vein, and PTA of the hepatic vein by way of the transhepatic approach, right cervical vein or inferior vena cava. Results The success rate was 100% (83/83) in type Ⅰ patients, 75.0% (9/12) in type Ⅱ patients, 81.6% (31/38) in type Ⅲ patients, and 60% (3/5) in type Ⅳ patients. One patient died (0.7%, 1/138). Complications occurred in 4 patients (2.9%, 4/138), including 2 cases of pericardial injury, 1 case of stent detachment, and 1 case of hepatic hemorrhage. Follow-up observations in 126 successful cases for 3~96 months (mean, 26 months) showed 8 recurrent cases, 2 of which expired, and 2 fatal cases because of hepatocarcinoma. Conclusions Interventional therapy, as a simple, safe and effective minimally invasive method, is the first choice for the treatment of BCS.

关 键 词：Budd—Chiari综合征 血管成形术 内支架 

分 类 号：R575[医药卫生—消化系统]