自展式血管内支架治疗Budd-Chiari综合征(附24例报告)

BUDD-CHIARI SYNDROME TREATED WITH SELF-EXPANDING INTRAVASCULAR STENT (Report of 24 cases)

目的报告２４例Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＢＣＳ）的介入治疗结果。方法在Ｘ线电视透视下，采用经皮血管成形术（ＰＴＡ）及血管内支架（ｓｔｅｎｔ）置入治疗下腔静脉和（或）肝静脉阻塞；下腔静脉支架２０例，副肝静脉支架１例，下腔静脉和肝左静脉双支架３例。结果２４例２７支血管皆一次性开通及支架置入获得成功。下腔静脉平均压力术前为３．５４±０．９１ｋＰａ，术后即刻降为２．０２±０．９８ｋＰａ。１例副肝静脉术前压力为３．２２ｋＰａ，术后即刻降为２．０６ｋＰａ。３例肝左静脉压力术前平均为６．１７±０．８２ｋＰａ，术后降为２．３５±０．８６ｋＰａ。术后随访平均４．６个月（１～１４个月），下腔静脉保持通畅，支架扩张良好，无移位。主要临床症状及体征消失者２１例，明显改善者３例，无严重并发症发生。结论介入治疗ＢＣＳ是一种安全有效的方法。在３支主肝静脉严重阻塞时，开通副肝静脉是治疗肝静脉型ＢＣＳ的有效途径。

Objective To review 24 cases of Budd-Chiari syndrome (BCS) treated by intervening radiological techniques. Methods 24 patients with stenosis of the inferior vena caca (IVC) and/or hepatic veins were treated by percutaneous angioplasty (PTA) plus intravascular stenting under X ray TV. 27 self-expanding stents were successfully placed in the 24 patients, 20 for the IVC, 1 for the parahepatic vein (PHV), and 3 pairs for the IVC and left hepatic vein (LHV). Results The venous pressure immediately dropped from 3.54±0.91 kPa to 2.02±0.98 kPa in IVC, from 3.22 kPa to 2.06 kPa in PHV, and from 6.17±0.82 kPa to 2.35±0.86 kPa in LHV.Follow-up 4.6 monthes later (1～14 monthes) revealed good patency of the IVC and well expanded stents without displacement. The clinical symptoms disappeared in 21 of the 24 patients and got markedly improved in the other 3.Conclusion Intervention radiology is safe and effective for treating BCS. When the 3 major hepatic veins are seriously obstructed, recanalization of the PHV is an effective approach to the hepatic vein type of BCS.