Budd-Chiari综合征肝静脉闭塞的介入治疗  

Interventional treatment for the occlusive hepatic veins in Budd-Chiari syndrome

作　　者：张曦彤[1] 徐克[1] 祖茂衡[2] 崔进国[3] 杨学良[4] 赵金旭 陈凯[6] 冯博[1] 苏洪英[1] 李红[1] 

机构地区：[1]中国医科大学附属第一医院放射科,沈阳110001 [2]徐州医学院附属医院介入放射科 [3]解放军白求恩国际和平医院放射科 [4]解放军第一五○医院 [5]山东省菏泽地区人民医院介入科 [6]天津医科大学附属第一医院放射科

出　　处：《中华放射学杂志》2003年第5期449-453,共5页Chinese Journal of Radiology

基　　金：国家"九.五"攻关项目 ( 96 - 90 7- 0 1- 0 2 )

摘　　要：目的　评价Budd Chiari综合征患者肝静脉闭塞介入治疗方法及中远期疗效。方法42例Budd Chiari综合征患者 ,男 17例 ,女 2 5例 ,年龄 18～ 5 7岁 (平均 34 5岁 ) ;肝功能ChildA级 2 3例 ,B级 6例 ,C级 13例。共计 92条肝静脉闭塞 ,其中左肝静脉 2 9条 ,中肝静脉 2 4条 ,右肝静脉 36条 ,副肝静脉 3条。34例伴有下腔静脉狭窄或闭塞。肝静脉治疗方法包括 :( 1)闭塞肝静脉穿通 (经颈、股静脉、经皮肝穿肝静脉或上述两种途径并用 ) ;( 2 )球囊导管扩张 ;( 3)内支架置入。 32例同时行下腔静脉经皮腔内血管成形术 (PTA)或内支架治疗。结果　 40例患者的 40条肝静脉均成功开通。PTA治疗后 8例置入内支架。 32例下腔静脉均获通畅。术前肝静脉压力为 34 5cmH2 O ( 2 5 .0～ 48.0cmH2 O) ( 1cmH2 O =0 .0 98kPa) ,术后降为 2 2 0cmH2 O( 12 .0～ 35 .0cmH2 O) (T =11.5 0 ,P <0 0 1)。术后患者症状体征完全缓解 32例 ,8例部分缓解。随访 1～ 5 4个月 (平均 2 7 5个月 ) ,1例因肝功能衰竭术后 1个月死亡 ,2例因肝静脉闭塞经 2次介入治疗再次获得开通。 5例未再接受复查和治疗。余32例均无症状再发 ,超声检查均无肝静脉再闭塞发生 (平均 2 8 9个月 )。结论 ( 1)肝静脉闭塞介入治疗方法多样 ,可综合应用 ;( 2 )Objective To evaluate the interventional methods for occlusive hepatic veins in Budd-Chiari syndrome and its mid and long-term effects. Methods Forty-two patients (male 17 cases and female 25 cases)aged from 18 to 57 years old (mean 34.5 years) were studied. The liver functions were Child A in 23 cases, Child B in 6 cases, and Child C in 13 cases, respectively. A total of 92 hepatic veins were occluded. Among them, 29 left hepatic veins , 24 middle hepatic veins, 36 right hepatic veins, and 3 accessory hepatic veins were occluded. Thirty-four patients were accompanied with the stenotic or occlusive inferior vena cave (IVC). The interventional methods included: (1) recanalization of occlusive hepatic veins (by transjugular, transfemoral, and percutaneous transhepatic route, or the combination of above three methods); (2) percutaneous transluminal angioplasty; (3) self-expanding stent implantation. The occlusive IVC in 32 patients also accepted PTA and/or stent implantation. Results The successful recanalization was carried out in forty hepatic veins in 40 patients. PTA of occlusive veins was followed by stent implantation in 8 patients. The pressure of hepatic veins dropped from 34.5 cm H 2O (25.0～48.0 cm H 2O) to 22.0 cm H 2O (12.0～35.0 cm H 2O) after intervention(T=11.50, P<0.01). The symptoms and pathological signs improved obviously in 32 cases and improved partly in 8 cases. During the follow-up period from 1 month to 54 months (mean 27.5 months), one cases died of liver function failure at one month after intervention. The re-intervention of occlusive veins in two cases were performed and the better results were acquired again. Five cases didn′t accept re-intervention. Neither recurrence of symptoms nor re-occlusion of hepatic veins was found in the other 32 patients. Conclusion (1) Multiple and synthetical interventional methods for the occlusive hepatic veins in Budd-Chiari syndrome can be utilized. (2) The intervention of hepatic vein is mini-invasive and can decrease the pressure of he

关 键 词：BUDD-CHIARI综合征 肝静脉闭塞 介入治疗 闭塞肝静脉穿通术 球囊导管扩张术 金属内支架置入术 

分 类 号：R657.34[医药卫生—外科学]