第二肝门重建术──一种治疗布卡氏综合征的新技术

Reestablishment of Second Hepatic Hilum──A New Techique for Treatment of Budd-Chiari Syndrome

目的：评价一种新的介入方法，即穿刺肝段下腔静脉与肝内静脉之间的肝实质并置入金属支撑架重建第二肝门来治疗缺少第二肝门的布卡氏综合征（BCS）。材料和方法：2例BCS病人经皮穿刺肝内静脉造影证实无第二肝门结构，分别采用经右侧颈静脉和经皮经肝穿刺途径，在肝段下腔静脉与肝内静脉之间经肝实质重建第一肝门，支撑架直径为10mm，术后半年复查肝静脉造影，并随访半年以上。结果：第二肝门重建后，肝内自由静脉压分别从37mmHg、28mmHg降至5mmHg和4mmHg，并维持不变。1例病人术后发生因肝包膜损伤引起的腹腔内出血。复查静脉造影显示支撑架通畅，无再狭窄。病人肝功能明显好转，各项实验室指标改善或恢复正常。结论：介入性第二肝门重建术与手术相比简单、安全，对第二肝门闭塞型BCS可望获得治愈疗效。

To evaluate a new interventional technique of reestablishing second hepatic hilum hy meansof punturing and stenting the hepatic parenchyma between intrahepatic vein and intrahepatic segment of in-ferior vena eava for the treatment of BCS. Materials and Methods: Two patients with BCS which had nosecond hepatic hilum diagnosed by transhepatic hepatovenography were treated by means of canaliring andstenting the parenchyma-tract between hepatic veins and inferior vena cava. The procedures were done per-cutaneorsly through jugular vein and transhepatic way respectively. The expandable metallic stents with10 mm diameter were implanted to maintain the tracts pency. Results: The free hepatic vein pressure(FHVP) of the patients were decreased from 37 mmHg to 5 mmHg and from 28mmHg to 4mmHg, respec-tively after treatment. The complication of hemorrhage due to puncture procedure was happened in one pa-tient. By 6 months follow-up intrahepatic venograms showed the stented canals maintained patency withoutstenosis and the FHVP still normal, the clinical situations including liver functions and laborlatory date getbetter than that before treatment. The symptoms due to disfunction of liver and hypertension of portal veinwere resolved significangly. Conclusion: This new technique Provides a simple, safe, effective, relatively in-expensive and potentially longlasting treatment for selected patients with BCS.