下腔静脉超长节段闭塞型Budd-chiari综合征的介入治疗

Interventional Therapy for IVC Super-long Segmental Occlusion of Budd-Chiari Syndrome

目的 探讨下腔静脉超长节段闭塞型Budd -chiari综合征的病理基础及采用介入技术治疗本型Budd -chiari综合征的疗效与安全性。方法 选取经B超及下腔静脉双向造影 ,下腔静脉病变段长度超过 5cm的患者 31例 (男 18例 ,女 12例 ) ,年龄 2 7～ 5 2岁 ,平均 32 .4岁 ,阻塞段长度 5～ 12cm (平均 7.1cm ) ,闭塞近远端压差 2 1～ 2 9cmH2 O ,平均 2 4 .6cmH2 O ,所有病例先行下腔静脉穿刺术 ,观察穿刺术中造影情况。穿刺成功后 ,观察PTA时球囊压迹的变化 ,并对 2 1例患者行内支架置放术。结果 2 8例患者治疗获得成功 ,总治疗成功率为 90 % ,其中 2 7例患者显示了下腔静脉双膜闭塞的影像学特征 ,治疗全部成功 ,成功率为 10 0 % ,腹水缓解率为 71% (2 2 / 31) ,腹水消失率为 35 % (11/ 31) ,闭塞近远端压差降至 5～ 12cmH2 O(平均 8.4cmH2 O)。结论 双膜闭塞为下腔静脉超长节段闭塞型Budd -chiari综合征的主要病理类型。其治疗成功率与下腔静脉膜性闭塞型Bud -chiari综合征成功率一致。

Objective To investigate the pathology of IVC super-long segmental occlusion of Budd-Chiari syndrome and the effect and safety of intervention in treating this type BCS. Methods All patients were performed by IVC puncture. Changes of balloon was observed at PTA and 21 patients were treated with placement of stent. Ultrasound and IVC radiography showed the length of IVC lessionic segment over 5cm was in 30 patients. (male 18 cases, female 12 cases),aged from 27～52 (average 32.4),the length of occlusion was 5～12cm.(mean 7.1cm).The pressure gradient of two sides of occlusion was 21～29cm H 2O (mean 24.6cm H 2O).Results 27 patients showed IVC bi-membraneous occlusionic imaging characteristics.28 patients were successful. The rate of success was 90%,27 patients with bi-membraneous occlusion were all succeeded.Abdomemal edema releasing rate was 71% (22/31). The deleting rate was 35% (11/31) . The gradient decreased to 5-12cm H 2O (average 8.4cm H 2O).Conclusion The rate of therapy was 100% and was concioned with IVC membraneous occlusionic BCS.