下腔静脉型布加综合征合并下腔静脉血栓形成的治疗及随访分析  

Treatment and Follow-Up Results of Inferior Vena Cava Blocking Budd-Chiari Syndrome with Thrombosis

作　　者：刘仕睿 李震[1] 丁鹏绪[1] 张文广[1] 化召辉[1] 吴智慧[1] 黄必润[1] 徐鹏[1] 李浩[1] 王志伟[1] 汪忠镐[1,2,3] 

机构地区：[1]郑州大学第一附属医院腔内血管外科,河南郑州450052 [2]首都医科大学宣武医院血管外科,北京100053 [3]第二炮兵总医院血管外科,北京100088

出　　处：《中国普外基础与临床杂志》2014年第12期1495-1499,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨下腔静脉（inferior vena cava,IVC）型布加综合征（Budd-Chiari syndrome,BCS）合并IVC血栓形成的治疗方法、疗效及预后。方法回顾性分析2004年4月至2012年6月期间因膜性或短段闭塞性IVC型BCS合并IVC血栓形成于郑州大学第一附属医院行介入治疗的128例患者的临床资料,比较行小球囊预开通治疗及可回收支架治疗患者的疗效。结果 128例患者中,9例行搅拌溶栓治疗（搅拌溶栓组）,56例行小球囊预开通治疗（预开通组）,63例行可回收支架治疗（可回收支架组）。除可回收支架组有1例患者于术中发生支架断裂、行外科手术外,其余127例患者的介入手术均成功。术后可回收支架组发生支架移位2例,余2组无并发症发生。预开通组与可回收支架组的尿激酶用量、溶栓时间、住院时间以及总并发症发生率比较差异均无统计学意义（P〉0.05）,但可回收支架组的住院费用高于预开通组（P〈0.01）。术后128例患者均获访,随访时间18-66个月,平均44.2个月。随访期间,搅拌溶栓组有1例、预开通组有6例、可回收支架组有6例患者发生原闭塞处的再次狭窄闭塞,预开通组与可回收支架组的再次狭窄闭塞率比较差异无统计学意义（P〉0.05）。复发患者经再次扩张治疗后未再发生管腔狭窄和血栓形成。结论搅拌溶栓技术治疗IVC型BCS合并IVC新鲜血栓形成安全而有效;小球囊预开通技术及可回收支架技术治疗IVC型BCS合并IVC陈旧性血栓形成的效果满意,且前者更经济。Objective To investigate therapeutic method, curative effect, and prognosis of inferior vena cava （IVC） blocking Budd-Chiari syndrome （BCS） with thrombosis. Methods Clinical data of 128 BCS patients with membranous or short-segment occlusion of IVC as well as IVC thrombosis, who accepted interventional treatment in The Affiliated Hospital of Zhengzhou University from Apr. 2004 to Jun. 2012, were retrospectively analyzed. Comparison of the difference on effect indicators between predilation group and stent filter group was performed. Results Thereinto, 9 patients with flesh IVC thrombosis were treated with agitation thrombolysis （agitation thrombolysis group）, 56 patients were predilated by small balloon （predilation group）, for the rest 63 patients, a stent filter was deployed （stent filter group）. Besides 1 stem filter fractured during the first removal attempt and had to be extracted surgically in the stem filter group （patients suffered with sent migration）, in addition, the surgeries of other patients were technically successful without procedure-related complication. Effect indicators were satisfactory in all patients, and there were no statistical differences between predilation group and stent filter group in dosage of urokinase, urokinase thrombolysis time, hospital stay, and incidence of complication （P〉0. 05）, but the cost ofpredilation group was lower than that of stent filter group （P〈0. 01）. All of the 128 patients were followed-up postoperation, and the duration range from 18 to 66 months with an average of 44. 2 months. During the follow-up period, reobstruction of the IVC was observed in 13 patients without thrombosis, of which 1 patient in agitation thrombolysis group, 6 patients in predilation group, and 6 patients in stent filter group. There was no significant difference in recurrence rate between predilation group and stent filter group （P〉0. 05）. Patients with recurrence got re-expansion treatment, and no stenosis or thrombogenesis recurred. Conclusi

关 键 词：布加综合征 下腔静脉 血栓 介入治疗 溶栓 

分 类 号：R543.6[医药卫生—心血管疾病]