Budd-Chiari综合征患者介入开通术后再狭窄处理和远期随访结果  

Management of postoperative restenosis in patients with Budd-Chiari syndrome after interventional recanalization and its long-term follow-up results

作　　者：张伟[1] 王巧争 陈晓伟 李启洋 韩金行 陈旭东 徐克[2] ZHANG Wei;WANG Qiaozheng;CHEN Xiaowei;LI Qiyang;HAN Jinhang;CHEN Xudong;XU Ke(Department of Interventional Radiology,Shenzhen Municipal People`s Hospital,Shenzhen,Guangdong Province 518020,China)

机构地区：[1]深圳市人民医院介入科,广东518020 [2]中国医科大学附属第一医院介入科

出　　处：《介入放射学杂志》2020年第9期883-887,共5页Journal of Interventional Radiology

摘　　要：目的探讨Budd-Chiari综合征患者介入开通术后再狭窄的治疗策略,评价远期随访结果。方法回顾性分析1983年11月至2013年12月60例原发性Budd-Chiari综合征介入开通术后出现再狭窄患者临床资料和随访结果。结果60例再狭窄患者根据初始开通术式分为单纯PTA治疗组(40例,其中混合型27例,下腔静脉型5例,肝静脉型8例)、PTA+支架植入组(20例,其中混合型13例,下腔静脉型6例,肝静脉型1例)。单纯PTA治疗组出院1年内、5年内、10年内发生再狭窄分别为15例(37.5%)、34例(85%)、38例(95%),PTA+支架植入组出院1年内、5年内、10年内发生再狭窄分别为10例(50%)、18例(90%)、19例(95%)。单纯PTA治疗组中13例拒绝治疗,27例接受进一步治疗,其中5例随访中出现第2次再狭窄,2例第3次再狭窄,1例第4次再狭窄;PTA+支架植入组中9例拒绝治疗,10例仅接受单纯PTA,另1例接受PTA+支架植入,5例随访中发生第2次再狭窄,3例第3次再狭窄,1例第4次再狭窄。38例再狭窄后接受进一步治疗患者1年、5年、10年、20年、25年累积生存率分别为分别为100%、78.3%、78.3%、70.5%、70.5%,22例拒绝进一步治疗患者分别为72.7%、45.9%、30.6%、10.2%、NA(未获得),两部分患者间差异有显著统计学意义(P<0.001)。结论Budd-Chiari综合征患者介入开通术后远期随访非常重要。积极治疗再狭窄可改善患者预后。根据疗效逐步升级侵入性治疗策略,取得了满意的结果。Objective To explore the treatment strategy for postoperative restenosis of Budd-Chiari syndrome(BCS)after interventional recanalization and to evaluate the long-term follow-up results.Methods The clinical data and follow-up results of 60 patients with primary BCS,who received interventional recanalization therapy from November 1983 to December 2013 and developed postoperative restenosis,were retrospectively analyzed.Results According to the initial recanalization method,the patients were divided into percutaneous transluminal angioplasty group(PTA group,n=40),in which BCS included mixed type(n=27),IVC type(n=5)and HV type(n=8),and PTA+stenting group(n=20),in which BCS included mixed type(n=13),IVC type(n=6)and HV type(n=1).After discharge,the one-,5-and 10-year restenosis incidences in the PTA group were 37.5%(n=15),85.0%(n=34)and 95.0%(n=38)respectively,which in the PTA+stenting group were 50.0%(n=10),90.0%(n=18)and 95.0%(n=19)respectively.In the PTA group,13 patients refused additional treatment and 27 patients received further treatment.During the follow-up period,5 patients developed restenosis again,and among the 5 patients 2 developed third recurrence of restenosis and one developed fourth recurrence of restenosis.In the PTA+stenting group,9 patients refused additional treatment,10 patients only received simple PTA,and one patient received PTA+stenting treatment again.During the follow-up period,5 patients developed restenosis again,3 patients developed third recurrence of restenosis,and one patient developed fourth recurrence of restenosis.The one-,5-and 10-,20-and 25-year cumulative survival rates in the 38 patients who developed restenosis and received further treatment were 100%,78.3%,78.3%,70.5%and 70.5%respectively,which in the 22 patients who refused to receive further treatment were 72.7%,45.9%,30.6%,10.2%and NA(not available)respectively,the differences were statistically significant(P<0.001).Conclusion Long-term follow-up is very important for BCS patients after receiving interventional recanaliz

关 键 词：BUDD-CHIARI综合征 介入开通 再狭窄 远期随访 治疗策略 

分 类 号：R445[医药卫生—影像医学与核医学]