不同类型下腔静脉阻塞型Budd-Chiari综合征的介入治疗  

Interventional Therapy in Different Type of Inferior Vena Cava Obstruction in Budd-Chiari Syndrome

作　　者：李海平[1] 李刚[1] 王小宜[1] 雷光武[1] 周正明[1] 李乔秀[1] 

机构地区：[1]中南大学湘雅医院放射科,湖南长沙410008

出　　处：《实用放射学杂志》2007年第5期673-676,共4页Journal of Practical Radiology

摘　　要：目的探讨不同类型下腔静脉阻塞型Budd-Chiari综合征(BCS)介入治疗方法,评价介入治疗BCS的价值。方法86例BCS患者均由DSA确诊,根据不同类型下腔静脉阻塞采用的介入治疗方法有下腔静脉经皮单纯球囊扩张成形术;球囊扩张术加支架置入术,血栓抽吸和溶栓术。结果56例下腔静脉膜性阻塞中54例完全开通,1例因隔膜太坚硬未能扩开,1例胸段下腔静脉破裂出血。15例下腔静脉节段性阻塞中14例获得良好开通,1例因闭塞段太长(约6 cm)开通未成功。6例下腔静脉内伴有新鲜血栓完全清除后获得开通;11例下腔静脉内伴有陈旧性附壁血栓10例获得开通。介入治疗BCS成功率95.8%(68/71,肝静脉型及混合型BCS除外),死亡率1.4%,复发率4.2%,未发生心包填塞、支架滑移、肺栓塞等严重并发症。结论介入治疗BCS是一种简单、创伤小、见效快的方法,绝大部分可替代外科手术治疗。对不同类型下腔静脉阻塞采用正确的治疗方法可减少并发症和复发率。Objective To investigate the role of interventional therapy in different type of inferior vena cava obstruction in Budd - Chiari syndrome （ BCS ）. Methods 86 patients with BCS diagnosed by DSA. On the basis of the different type of obstruction of the inferior vena cava , the interventional proceduces included percutaneous transluminal angioplasty （PTA） , PTA plus stent placement of inferior vena cava, suction thromhectomy and thromholytic therapy. Results 56 patients were membranous obstruction of the inferior vena cava （ MOVC ） ,among of these, after operation,54 cases were complete unhlocked, 1 ease was defeated because of stiff membrane, 1 ease was defeated because of inferior vena haemorrhage . 15 patients were segment obstruction of the inferior vena cava （ SOVC ） , among of these, 14 cases were complete unhlocked, 1 ease was defeated because the occlusive segment was too long to he dilated. 6 patients had recent thromhus in the inferior vena cava ,all were complete unhlocked. 11 patients had organized intraluminal thromhus in the inferior vena cava, of them, 10 cases complete unblocked. The successful rate of interventional therapy was 95.8% （68/71） , with the exception of hepatic vein and of both in BCS,and the mortality was 1.4% . the recurrent rate was 4.2% ,without serious complications,such as hemopericadiun, stent migration and pulmonary embolism. Conclusion Interventional therapy is a simple, safe and effective procedure for BCS,which can replace surgery in most patients. For different type of inferior vena cava obstruction in BCS, using appropriate interventional therapy can reduce the complication and restenosis rate.

关 键 词：下腔静脉 静脉血栓形成 介入放射学 血管成形术 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]