改良式Z-支架在布-加综合征介入治疗中的应用(英文)  

Application of modified Z-stent in interventional therapy of Budd-Chiari syndrome

作　　者：张逢吉[1] 张旋 秦双[1] 张德景 元文勇[1] 苏国强[1] 梁玉兰 

机构地区：[1]新乡医学院一附院普外科,河南卫辉453100 [2]中原油田总医院普外科,河南濮阳457001

出　　处：《新乡医学院学报》2003年第5期305-307,共3页Journal of Xinxiang Medical University

摘　　要：目的　探讨改良式Z stent在布 加综合征 (BCS)介入治疗中的应用价值。方法　回顾性分析二家医院的 12例BCS。全组病例在手术前均作彩色Doppler检查 ,确定病变部位和性质 ,选择支架类型。术中在DSA监视下作腔静脉造影 ,破膜、扩张。然后正确置入带有标记的改良式支架 ,将缺口部分的一侧对准肝静脉开口处 ,再作腔静脉造影和 (或 )肝静脉造影 ,确定支架放置部位是否正确。本组 12例下腔静脉膜性阻塞或节段性阻塞 ,全部使用改良式支架。结果　破膜扩张后下腔静脉压由 2 7.3 3± 4.12cmH2 O降至 18.67± 5 .0 7cmH2 O(P <0 .0 1) ,放置支架后下腔静脉压由 18.67± 5 .0 7cmH2 O降至 11.42± 2 .11cmH2 O(P <0 .0 1)。随访 2 .5年肝静脉和下腔静脉均无血栓形成 ,说明改良支架可预防压迫肝静脉开口和防止下腔静脉狭窄部的回缩。结论　改良式Z stent腔内支架预防血栓形成是一种安全有效的方法 ,远期效果尚待进一步观察。Objective To evaluate the utility of modified Z stent in treatment for Budd Chiari syndrome (BCS).Methods A retrospective study was used in twelve BCS patients treated in two hospitals. The Doppler examination was carried out in all patients preoperatively, so as to confirm the nature of the lesion and chose correct type of endovascular modified Z stent. Under DSA monitoring for membranotomy and dilation of the inferior vena cava(IVC), after that, insert the marked modified Z stent to IVC correctly,and put the non stent part to hepatic vein orifice. The cavography and hepatic venography should confirm the position of the Z stent. All of 12 patients with membranous obstruction of the IVC(MOVC) or segmental obstruction of the IVC(SOVC)were underwent modified Z stent placement.Results The IVC pressure (IVCP) before smd after membranotomy (dilation) were 27.33±4.12cmH 2O and 18.67±5.07cmH 2O ( P <0.01). Comparing with dilation and putting stent group, the IVCP decreased from 18.67±5.07cmH 2O to 11.42±2.11cmH 2O ( P <0.01). The modffied Z stent could avoid hepatic vein orifice getting compression and resist the retraction of IVC throughly in following up period of 2.5 years.Conclusions The endovascular treatment of BCS with modified Z stent is more effective and safer to prevent thrombosis. Further study will be required to observe their long term effects.

关 键 词：布加综合征 肝静脉 血栓形成 改良式Z-stent 

分 类 号：R656[医药卫生—外科学]