节段性狭窄闭塞布-加综合征的介入治疗  

Interventional treatment of segmental stenotic or occlusive Budd-Chiari syndrome

作　　者：闫争强[1] 王妍心[2] 孔凡明[1] 朱绍辉[1] 赫鹏[1] 王云检[1] 

机构地区：[1]新乡医学院第一附属医院普外科,河南省卫辉市453100 [2]新乡医学院第一附属医院麻醉科,河南省卫辉市453100

出　　处：《中国综合临床》2004年第5期447-448,共2页Clinical Medicine of China

摘　　要：目的　探讨布 加综合征 (BCS)下腔静脉节段性狭窄、闭塞合并肝静脉阻塞的介入治疗。方法　 2 8例节段性狭窄、节段闭塞患者 ,多数合并 1～ 3支肝静脉闭塞 ,无合并下腔静脉血栓形成。应用球囊导管或房间隔穿刺针行下腔静脉开通术 ,下腔静脉开通后用 2 .0～ 2 .3cm球囊扩张后放入金属内支架。术后抗凝治疗 2年。结果　 2 7例患者成功进行了经皮穿刺球囊破膜扩张 ,即经皮腔内血管成形术 (PTA)和血管内支架植入治疗。闭塞肝静脉多数扩张下腔静脉后同时开通。患者肝、脾缩小 ,腹水吸收。 1例穿破下腔静脉急诊手术止血。随访 2～ 36个月未见复发及消化道出血。结论　下腔静脉狭窄者注意有肝静脉闭塞 ;下腔静脉闭塞破膜后 ,2 0例肝静脉闭塞者 19例随之开放 ,无需特殊处理 ;安放支架时注意保护肝静脉入口。Objective To evaluate the interventional therapy for segmental stenotic or occlusive Budd Chiari syndrome complicated with obstruction of hepatic vein.Methods Most of 28 cases of segmental stenosis or occlusion were complicated with obstruction in 1 to 3 hepatic veins and no thrombosis of inferior vena cava was complicated.The opening operation of the inferior vena cava was done with saccular catheter or atrial septum puncture needle.After the opening of inferior vena cava,the dilation was done with a 2.0 2.3 cm balloon and then metal stent was put in.Postoperative anticoagulant therapy was conducted for 2 years.Results 27 cases were successfully treated with percutaneous puncture and balloon dilation of rupture of membranes,percutaneous transluminal angioplasty(PTA),as well as the implantation of metal stent in blood vessel.As inferior vena cava was opened the hepatic veins of obstruction were opened at the same time.The hepato lienal shrinkage and the absorption of ascites were observed after the operation.1 case was treated with emergency operation by puncturing the inferior vena cava.During 2 36 months follow up,there was no relapse of symptoms or digestive tract bleeding.Conclusion It should be noted that the cases with stenotic inferior vena cava often go with occlusive hepatic veins.When the rupture of membranes in stenotic inferior vena cava happens,hepatic veins open in 19 cases of 20 hepatic vein occlusion as a result.Therefore no special treatment is needed.The orifice of hepatic veins should be protected during the implantation of metal stent.

关 键 词：布-加综合征 血管成形术/气囊 介入疗法 

分 类 号：R657.3[医药卫生—外科学]