布-加综合征的治疗

Treatment of 260 Cases with Budd-Chiari Syndrome

目的 探讨布 -加综合征各种治疗方法的疗效。方法 对 2 6 0例布 -加综合征病人采用介入、手术或介入联合手术治疗 2 73例次 ,其中下腔静脉成形术或 (和 )支架置入术 16 0例次 ,肝静脉或副肝静脉成型术或 (和 )支架置入术 17例次 ,下腔静脉加肝静脉或副肝静脉成型术或 (和 )支架置入术 10例次 ;常温直视根治术 8例次 ,肠腔转流术 16例次 ,肠颈转流术 5例次 ,肠房转流术 8例次 ,腔房转流术 6例次 ,脾肺固定术 18例次 ;肠腔转流联合下腔静脉成形术和支架置入术 17例次 ,经右房手指破膜术联合下腔静脉成形术和支架置入术 8例次。结果 下腔静脉压由术前 2 8～ 39cmH2 O下降至术后 12～ 2 0cmH2 O。门脉压由术前 2 9～ 4 5cmH2 O下降至术后 2 4～ 2 8cmH2 O。肝静脉压由术前 2 6～ 36cmH2 O下降至术后 8～ 18cmH2 O。手术死亡 2例 ,1例介入病人心包填塞死亡 ,1例手术病人大出血死亡。随访 3个月～ 6年 ,2 0例复发综合病征 ;其中 7例死于肝衰 ,其余病人恢复满意。结论布 -加综合征首选介入治疗 ,不宜介入或介入失败及复发者应选用手术或介入联合手术治疗 ,治疗效果良好。

Objective To study the effect of every treatment methods for the Budd-Chiari syndrome. Methods 260 cases with BCS were treated with interventional treatment?operative treatment or operation combining interventional therapy all together 273 times,including PTA or/and stenting of inferior vena cava 160 times, PTA or/and stenting of hepatic venous 17 times and above two methods combined 10times;radical resection in room temperature 8 times,mesocaval shunt 16 times,mesojugular shunt 5 times,mesoatriumr shunt 8 times,IVC-atrium shunt 6 times,splenopneumoexy 18 times;mesocaval shunt combining PTA and stenting of IVC 17 times,combined transcardic membranotomy and PTA and stenting of IVC 8 times. Results After the treatment,the IVC pressure declined from 28～39cmH 2O to 12～20cmH 2O,the portal venous pressure declined from 29～45cmH 2O to 24～28cmH 2O,the hepatic venous pressure declined from 26～36cmH 2O to 8～18cmH 2O, the operative mortality was 2 cases,1 case died of cardiac tamponade,1 case died of operrative hemorrhagic shock.20 cases relapsed,among them 7 paients died of hepatic failure,the other patients recovered satisfactarily during the follow-up period of 3 months-6 years. Conclusion The interventional treatment is the first choice for BCS,while alternative treatment for the patients unable to get interventional treatment or get failed and the patients relapsed,should choose operation or operation combining interventional therapy.