Z形自膨式金属支架治疗节段性下腔静脉型Budd-Chiari综合征中长期随访结果  

Z- expandable metallic stent implantation for the treatment of segmental inferior vena cava type Budd-Chiari syndrome: mid- to- long- term follow- up results

作　　者：赵志强 张书波 毛彦彬 董燕 李妍 付永立 丁鹏绪[4] 李震[4] 汪忠镐[4] 耿军锋 屈松跃 李振周 

机构地区：[1]河北省宁晋县中西医结合医院放射科,055550 [2]河北省宁晋县中西医结合医院功能科,055550 [3]河北省宁晋县中西医结合医院急诊创伤科,055550 [4]郑州大学第一附属医院腔内血管外科

出　　处：《介入放射学杂志》2016年第5期391-395,共5页Journal of Interventional Radiology

摘　　要：目的评价Z形自膨式金属支架（Z—SEMS）在节段性下腔静脉型Budd—Chiari综合征（BCS）介入治疗中的应用及中长期随访结果。方法回顾性分析2004年8月至2014年12月接受Z—SEMS支架治疗的41例节段性下腔静脉型BCS患者临床资料．并收集术后累计1、2、2～5、5～10年随访数据。结果41例患者均成功接受经皮球囊血管成形术（PTBA）和Z-SEMS支架植入术．术后患者下腔静脉高压症状明显改善，显效35例（85．4％），有效6例（14．6％），总有效率100％。4例患者（9．8％）出现支架移位并发症。所有患者获随访1～125个月．平均（64．12±41．48）个月，1例患者术后4个月出现门静脉高压症状，作经颈内静脉途径门腔分流术后缓解，4例新发肝细胞癌，5例死亡。4例（9．8％）支架再阻塞，再次PTBA术恢复通畅。累计1、2、2～5、5～10年下腔静脉一次通畅率分别为95．1％（39／41）、94．1％（32／34）、90．3％（28／31）、83．3％（20，24），二次通畅率分别为100％（41／41）、100％（34／34）、100％（31／31）、100％（24／24）。结论Z-SEMS支架治疗节段性下腔静脉BCS安全有效，再阻塞率低，中长期疗效满意。术后应注意随访支架及新发肝细胞癌。Objective To discuss the application of percutaneous Z-expandable metallic stent （Z- EMS） implantation in treating segmental inferior vena cava type Budd-Chiari syndrome （BCS） and to analyze its mid-to-long-term results. Methods The clinical data of 41 consecutive BCS patients with segmental obstruction of inferior vena cava （SOIVC）, who were admitted to authors＇ hospital to receive percutaneous Z- EMS implantation during the period from August 2004 to December 2014, were retrospectively analyzed. The cumulative follow-up data of one, 2, 2-5 and 5-10 years were collected. Results Both pereutaneous transluminal balloon angioplasty （PTBA） and Z-EMSimplantation were successful accomplished in all 41 patients. After the treatment, the symptoms of inferior vena cava （IVC） hypertension were obviously improved; significant response was achieved in 35 patients （85.4%） and curative effect in 6 patients （14.6%）, the total effect rate being 100%. Stent migration occurred in 4 patients （9.8%）. All patients were followed up for 1-125 months, with a mean of （64.12±41.48） months. One patient developed IVC hypertension at 4 months after treatment, which was relieved after receiving transjugular intrahepatic portosystemic stent shunting; 4 patients developed hepatocellular carcinoma （HCC） and 5 patients died. Re-obstruction of the stent was seen in 4 patients and the stent returned to patent after receiving PTBA. The cumulative primary patency rates of IVC at one, 2, 2-5 and 5-10 years were 95.1% （39/41）, 94.1% （32/34）, 90.3% （28/31） and 83.3% （20/24）respectively, while the secondary patency rates of IVC at one, 2, 2-5 and 5-10 years were 100% （41/41）, 100% （34/34）, 100% （31/31） and 100% （24/24） respectively. Conclusion For the treatment of segmental inferior vena cava type Budd-Chiari syndrome, Z-EMS implantation is safe and effective, its re-occlusion rate is lower and its mid-to-long-term result is satisfactory. Follow-up observation should be focused o

关 键 词：Budd—Chiari综合征 下腔静脉 血管内支架 经皮球囊血管成形术 

分 类 号：R543.6[医药卫生—心血管疾病]