布-加综合征肾静脉开口以上下腔静脉闭塞介入治疗效果  

The curative effect of interventional therapy for IVC occlusion above the renal vein origin in patients with BCS

作　　者：冯中秋 张庆桥 徐浩 祖茂衡 顾玉明 肖晋昌 神斌 黄乾鑫 FENG Zhongqiu;ZHANG Qingqiao;XU Hao;ZU Maoheng;GU Yuming;XIAO Jinchang;SHEN Bin;HUANG Qianxin(Department of Interventional Radiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221006,China)

机构地区：[1]徐州医科大学附属医院介入科,江苏221006

出　　处：《介入放射学杂志》2020年第5期454-457,共4页Journal of Interventional Radiology

摘　　要：目的评价布-加综合征(BCS)肾静脉开口以上下腔静脉闭塞介入治疗的效果。方法回顾性分析28例BCS肾静脉开口以上下腔静脉闭塞患者临床资料。所有患者均经右颈内静脉途径和右股静脉途径行下腔静脉开通治疗;22例经右颈内静脉途径,6例联合经皮经肝途径施行肝静脉开通治疗。术后采用彩色多普勒超声随访,观察下腔静脉和肝静脉畅通情况。结果28例患者介入手术均获成功,下腔静脉单纯球囊扩张术16例,支架植入12例。开通1支肝静脉17例,开通2支肝静脉11例。术后造影均显示下腔静脉、肝静脉血流通畅,无血管破裂出血等并发症发生。28例患者随访6~79个月,平均(42.6±24.5)个月。下腔静脉单纯球囊扩张患者再闭塞率为43.8%(7/16),下腔静脉支架植入患者再闭塞率为8.3%(1/12),差异有统计学意义(P<0.05);肝静脉再闭塞率为28.6%(8/28)。结论BCS肾静脉开口以上下腔静脉闭塞介入治疗安全有效,下腔静脉长段闭塞支架植入疗效优于球囊扩张。Objective To evaluate the curative effect of interventional therapy for the occlusion of inferior vena cava(IVC) above the renal vein origin in patients with Budd-Chiari syndrome(BCS). Methods The clinical data of 28 BCS patients associated with occlusion of IVC above the renal vein origin were retrospectively analyzed. The recanalization of IVC via right internal jugular vein approach and right femoral vein approach was carried out in all patients. The hepatic vein was recanalized through balloon dilation via right internal jugular vein approach(n =22), or combined with percutaneous transhepatic approach(n =6).After treatment, color Doppler ultrasound was performed to check the patency of IVC and hepatic vein.Results Successful interventional treatment was accomplished in all 28 BCS patients. The interventional methods included simple balloon dilation of IVC(n=16) and stent implantation(n=12). Recanalization of one hepatic vein was achieved in 17 patients, and recanalization of two hepatic veins was achieved in 11 patients.Postoperative angiography showed that the blood flow in both IVC and hepatic veins was unobstructed, and no complications such as rupture or bleeding of blood vessels occurred. All 28 patients were followed up for 6-79 months, with a mean of(42.6±24.5) months. The re-occlusion rate in patients receiving simple balloon dilatation of IVC was 43.8%(7/16), which was 8.3%(1/12) in patients receiving stent implantation of IVC, the difference between the two groups was statistically significant(P<0.05). The re-occlusion rate of hepatic veins was 28.6%(8/28). Conclusion For the occlusion of IVC above the renal vein origin in BCS patients,the interventional therapy is safe and effective. Stent implantation is superior to balloon dilation in treating long-segment obstruction of IVC.

关 键 词：布-加综合征 下腔静脉 肝静脉 介入治疗 

分 类 号：R575[医药卫生—消化系统]