节段性和非节段性下腔静脉阻塞型布加综合征腔内治疗的疗效分析  

Therapeutic effect of interventional therapy for Budd-Chiari syndrome with segmental and non-segmental inferior vena cava obstruction

作　　者：樊刚[1] 孙璐瑛 张林凤 Fan Gang;Sun Luying;Zhang Linfeng(Department of Intervention,Baoji Hospital of Traditional Chinese Medicine,Baoji 721001,China;Department of Medical Imaging,The Second People's Hospital of Shaanxi Province,Xi'an 710005,China)

机构地区：[1]宝鸡市中医医院介入科,陕西宝鸡721001 [2]陕西省第二人民医院医学影像科,陕西西安710005

出　　处：《中国血管外科杂志（电子版）》2023年第1期51-55,60,共6页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：陕西省社会发展科技攻关项目(2016SF-199)。

摘　　要：目的分析节段性和非节段性下腔静脉(inferior vena cava,IVC)阻塞型布加综合征(Budd-Chiari syndrome,BCS)患者腔内治疗的疗效。方法回顾性分析宝鸡市中医医院2015年1月至2019年1月收治的98例行球囊扩张或支架植入开通IVC的IVC阻塞型BCS患者的临床资料,比较患者治疗前后下腔静脉-右心房(inferior vena cava-right atrial,IVC-RA)压力差,以及节段性和非节段性阻塞患者、球囊扩张和支架植入患者的术后IVC通畅率。结果腔内手术技术成功率为100.0%,无发生心包填塞、IVC破裂、支架移位等并发症,无手术相关死亡。全组患者IVC-RA压力差从治疗前的(26.6±6.9)cmH2O(1 cmH2O=0.098 kPa)降至治疗后的(7.0±2.8)cmH2O,差异有统计学意义(t=26.529,P<0.001)。患者术后1、2和3年IVC累积通畅率分别为97.9%,91.7%和82.3%;其中,节段性阻塞患者分别为96.1%、89.4%和75.4%,非节段性阻塞患者分别为100.0%、94.5%和91.1%,两组差异无统计学意义(χ^(2) =1.714,P=0.191)。节段性IVC阻塞型BCS患者中,球囊扩张术后1、2和3年的IVC累积通畅率分别为87.5%、72.9%和36.5%,支架植入术后分别为97.7%、92.8%和88.2%,两组差异有统计学意义(χ^(2) =5.696,P=0.017)。非节段性IVC阻塞型BCS患者中,球囊扩张术后1、2和3年的IVC累积通畅率分别为100.0%、97.0%和92.6%,支架植入术后分别为100.0%、85.7%和85.7%,两组差异无统计学意义(χ^(2) =0.318,P=0.573)。结论IVC阻塞型BCS患者行腔内治疗是安全、有效的。节段性阻塞患者建议常规行支架植入术,而非节段性阻塞患者如单纯球囊扩张能很好地解除IVC阻塞,则不建议植入支架。Objective To analyze the efficacy of interventional therapy in Budd-Chiari syndrome(BCS)patients with segmental and non-segmental inferior vena cava(IVC)obstruction.Methods The clinical data of 98 BCS patients with IVC obstruction treated by balloon dilation or stenting in Baoji Hospital of Traditional Chinese Medicine from January 2015 to January 2019 were analyzed retrospectively.Inferior vena cava-right atrial(IVC-RA)pressure gradient,postoperative IVC patency in patients with segmental and nonsegmental obstruction,balloon dilatation and stenting were compared.Results The technical success rate of the interventional surgery was 100.0%.There were no complications such as pericardial tamponade,IVC rupture,and stent displacement,and no surgery-related death.The IVC-RA pressure difference of the whole group decreased from(26.6±6.9)cmH2O before treatment to(7.0±2.8)cmH2O after treatment,and the difference was statistically significant(t=26.529,P<0.001).The cumulative patency rates of IVC at 1,2 and 3 years after operation were 97.9%,91.7%and 82.3%,respectively.Among them,the patients with segmental obstruction were 96.1%,89.4%and 75.4%,and the patients with non-segmental obstruction were 100.0%,94.5%and 91.1%,the difference was not statistically significant(χ^(2) =1.714,P=0.191).In BCS patients with segmental IVC obstruction,the cumulative IVC patency rates at 1,2 and 3 years after balloon dilation were 87.5%,72.9%and 36.5%,respectively,and 97.7%,92.8%and 88.2%after stenting,the difference was statistically significant(χ^(2) =5.696,P=0.017).In BCS patients with non-segmental IVC obstruction,the cumulative IVC patency rates at 1,2 and 3 years after balloon dilation were 100.0%,97.0%and 92.6%,respectively,and 100.0%,85.7%and 85.7%after stenting,the difference was not statistically significant(χ^(2) =0.318,P=0.573).Conclusion Interventional therapy for BCS patients with IVC obstruction is safe and effective.For patients with segmental IVC obstruction,routine stenting is recommended.For patients with non-segmental

关 键 词：布加综合征 下腔静脉 腔内治疗 支架 球囊 通畅率 

分 类 号：R654.4[医药卫生—外科学]