布-加综合征介入治疗——导丝贯穿法行下腔静脉和肝静脉成形术

Interventional treatment of Budd-Chiari syndrome: guide wire penetrating angioplasty of inferior vane cava and hepatic vein

目的介绍布-加综合征介入治疗的新技术,评价导丝贯穿法行下腔静脉和肝静脉成形术的应用价值。方法54例布-加综合征患者,其中43例下腔静脉节段性闭塞采用经颈静脉途径穿刺破膜后将导丝由颈静脉途径进入下腔静脉、经股静脉引出;10例经皮经肝穿刺肝静脉,导丝经右心房、上腔静脉、颈静脉引出,1例导丝经股静脉进入下腔静脉、副肝静脉进入,经肝静脉和颈静脉引出,导丝贯穿于下腔静脉或肝静脉后以球囊扩张闭塞段。结果54例患者采用此项技术全部取得成功,临床症状消失,未出现并发症。结论贯穿法行下腔静脉和肝静脉成形术特别适用于下腔静脉节段性闭塞和肝静脉闭塞的病例,是一种简便、安全和实用的方法。

Objective To introduce a new method of guide-wire penetrating angioplasty of IVC and HV for Budd-Chiari syndrome with clinical evaluation. Methods Guide-wire was inserted into jugular vein passing through SVC and IVC and terminating out via femoral vein after penetrating through the occlusions in 43 cases with segmental occlusions of IVC. Another 10 cases with percutaneous transhepatic hepatic vein approach, the guide-wire passed through right atrium, SVC and terminated out of jugular vein, 1 case with femoral vein approach, the guide-wire entered IVC, hepatic accessory vein and terminated out of jugular vein. After penetration of IVC or hepatic vein, the occlusive segments were undertaken balloon dilation. Results Successful angioplasty of the IVC and hepatic vein was adopted with guide-wire penetration interventional technique in 54 cases without complication and with simultaneously symptom release. Conclusion Guide-wire penetrating angioplasty of IVC and hepatic vein especially for IVC and hepatic venous segmental occlusions is a simple, safe and practical method. （J Intervent Radiol, 2006, 15： 521-523）