1246例布加综合征介入治疗的方法与安全性分析  

Method and safety analysis of interventional treatment of Budd-Chiari syndrome in 1246 patients

作　　者：王磊[1] 齐瑞兆[2] 岳振东[1] 赵洪伟 范振华[1] 何福亮[1] 赵云[3] 桑泽杰 李志伟[2] 刘福全[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院介入治疗科,100038 [2]解放军第三○二医院普通外科,北京100039 [3]解放军第三○二医院介入治疗科,北京100039

出　　处：《中华消化外科杂志》2016年第7期702-708,共7页Chinese Journal of Digestive Surgery

基　　金：北京市医院管理局临床技术创新项目（XMLX201509）

摘　　要：目的 分析介入治疗布加综合征的方法与安全性.方法 采用回顾性横断面研究方法.收集1993年10月至2015年2月首都医科大学附属北京世纪坛医院收治的1 246例布加综合征介入治疗患者的临床病理资料.根据布加综合征的分型、程度和患者的临床症状,分别施行经皮穿刺腔静脉或肝静脉球囊成形术,下腔静脉、肝静脉或侧支血管支架成形术,腔静脉和肝静脉联合支架成形术,肝静脉成形联合经皮肝穿刺胃冠状静脉栓塞术,经颈静脉肝内门体分流（TIPS）联合下腔静脉（或肝静脉）支架成形术,TIPS.观察指标：（1）手术治疗结果.（2）手术并发症.（3）手术前后血管压力变化.符合正态分布的计量资料以-x±s表示,重复测量数据采用重复测量方差分析.结果 （1）手术治疗结果：1 246例布加综合征患者中,1 241例成功行介入治疗,其中经皮穿刺下腔静脉或肝静脉单球囊成形术163例、双球囊成形术61例,下腔静脉或肝静脉（或侧支血管）支架成形术611例,下腔静脉和肝静脉联合支架成形术85例,肝静脉成形联合经皮肝穿刺胃冠状静脉栓塞术13例,TIPS联合下腔静脉支架成形术58例,TIPS和肝静脉联合支架成形术7例,TIPS 243例.5例患者未成功行介入治疗,其中下腔静脉长段闭塞无法开通2例、肝静脉部分闭塞无法开通2例、肝静脉完全闭塞TIPS失败1例.（2）手术并发症：1例患者因经皮肝穿刺胸腔大出血,呼吸循环衰竭死亡.4例患者发生严重手术并发症,其中腹腔出血1例,下腔静脉支架部分移位至右心房内引起心包大量积液1例,肝静脉支架急性闭塞1例,穿透右心房、心包,引起心包积液1例,上述并发症均经对症治疗后好转、治愈.（3）手术前后血管压力变化：门静脉压力由术前的（3.8 ±0.7） kPa降至术后的（2.3 ±0.6）kPa,下腔静脉压力由术前的（2.9±0.4）kPa降至术后的（1.7 零0.5）kPa,肝静脉压力由Objective To analysis the method and safety of interventional treatment of Budd-Chiari syndrome （BCS）.Methods The retrospective cross-sectional study was adopted.The clinicopathological data of 1 246 patients with BCS who underwent interventional treatment at the Beijing Shijitan Hospital of Capital Medical University between October 1993 and February 2015 were collected.According to the classification and level of BCS and clinical symptoms of patients,percutaneous vena cava and hepatic vein balloon angioplasty,inferior vena cava or hepatic vein or collateral vessels stent angioplasty,vena cava and hepatic vein combined with stent angioplasty,hepatic vein angioplasty combined with percutaneous transhepatic embolization of coronary vein of stomach,transjugular intrahepatic portosystemic shunt （TIPS） combined with inferior vena cava （hepatic vein） stent angioplasty and TIPS were conducted.Observation indicators included （1） results of surgical treatment,（2） surgery-related complications,（3） changes of pre-and post-operative vascular pressures.Measurement data with normal distribution were presented as-x ± s,and repeated measures data were analyzed by the repeated measures ANOVA.Results （1） Results of surgical treatment：1 241 of 1 246 patients with BCS received successful interventional treatment,including 163 undergoing percutaneous inferior vena cava or hepatic vein balloon angioplasty,61 undergoing double balloon angioplasty,611 undergoing inferior vena cava or hepatic vein or collateral vessels stent angioplasty,85 undergoing inferior vena cava and hepatic vein combined with stent angioplasty,13 undergoing hepatic vein angioplasty combined with percutaneous transhepatic embolization of coronary vein of stomach,58 undergoing TIPS combined with inferior vena cava stent angioplasty,7 undergoing TIPS combined with hepatic vein stent angioplasty and 243 undergoing TIPS.Five patients didn＇t receive successful interventional treatment,including that occlusion in the length of inferior v

关 键 词：布加综合征 介入放射学 

分 类 号：R575[医药卫生—消化系统]