血管内支架置入术治疗节段性Budd－Chiari综合征的临床观察（附12例报告）

Clinical Observation of Segmental BCS Treated with EMS(A Report of 12 Cases )

作者报告了采用自张式金属血管内支架（ＥＭＳ）置入术对１２例节段性Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ｓＣＳ）患者进行治疗的临床结果。其中肝后段下腔静脉节段性阻塞型９例；节段性狭窄型３例。术后患者主要临床症状及体征消失或明显改善，下腔静脉平均压力由术前３．４０±０．６０ｋＰａ降为１．７４±０．３５ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）。２例于术后复查了血管造影，１例于术后第６个月时虽有管腔内膜增生，但该段下腔静脉依然通畅；另１例于术后３０个月时，病变段出现狭窄，经球囊导管成形术（ＰＴＡ）并置入另一组ＥＭＳ后，管腔再度获得通畅。其余１０例术后随访８～２８个月（平均１５个月）无症状再发生。作者认为ＥＭＳ置入术是治疗节段性ＢＣＳ的有效方法，可提高临床治疗效果，降低单纯ＰＴＡ治疗术后再狭窄闭塞发生率。

This paper reported the clinical resuIts of 12 cases of segmental Budd-Chiari syn- drome(BCS)treated with expandable metallic stent(EMS ).9 cases had segmental obstruction of hepatic portion of IVC and 2 cases had stenosis.After the procedure,the main clinical symptoms and signs such as varicosity of thoraco-abdominal wall and debilitating edema of lower body disappeared or markedly improved in all patients.The mean blood pressure in the IVC dropped from 3.40 ± 0.60kPa to 1.74±0.35kPa immediately after stenting.In follow-up study,angiography was performed in 2 cases.Intimal hyperplasia was found in 1 case but with good patency of the stent 6 months after EMS.In the other case,restenosis was demonstrated 30 months after EMS,stent in stent was done with good result.The remaining 10 cases were followed up for 8-28 months(mean 15 months)without recurrence of symptoms. The authors are of the opinion that EMS placement is an effective method for the treatment of segmental EMS by improving the clinical therapeutic effect and reducing the occurrence of postoperative restenosis/reobstriction and is therefore superior to PTA.