介入治疗下腔静脉节段闭塞型Budd-Chiari综合征的方法学研究

Methodological study of interventional therapy for segmental total occlusion of the retrohepatic inferior vena cava in Budd-Chiari Syndrome

目的探讨介入治疗下腔静脉节段闭塞型Budd-Chiari综合征（BCS）的有效方法。方法对经造影确诊的26例下腔静脉肝后段节段型完全闭塞型BCS患者，采用聚乙烯球囊导管或国产Inoue球囊导管行经皮腔内血管成形术（PTA）及支架置入，其中闭塞段穿刺过程中综合运用直接穿刺技术、导管挤钻技术、逆向穿刺技术、双向穿刺技术、导丝轨道技术。PTA前后行下腔静脉造影及血液动力学检查；观察患者临床表现变化及并发症发生情况。结果23例成功穿通闭塞段并行PTA治疗，均无严重并发症，技术成功率为88．5％；15例置入下腔静脉支架。术后闭塞段下腔静脉内径为（19．20±6．21）cm，下腔静脉压、下腔静脉至右房压力阶差显著降低，右心房压显著升高；随访1～5a复发3例。结论介入治疗下腔静脉节段闭塞型BCS安全、有效，综合应用各种穿刺技术及合理选择球囊导管类型、直径可提高成功率、减少并发症。

Objective To explore the effective method of interventional therapy for segmental total occlusion of the retrohepatie inferior vena cava（IVC） in Budd-Chiari Syndrome （BCS）. Methods Twenty-six patients with segmental total occlusion of the retrohepatic IVC were diagnosed by angiography and underwent pereutaneous transluminal angioplasty（PTA） and stunt placement. Inferior vena cava angiography were performed and hemodynamics parameter were measured. The techniques for puncture and recanalization included direct puncture technique,catheter drill technique,converse puncture technique, double direction puncture technique, wire track technique. Results Twenty-three cases were successfully punctured and recanalized with PTA without serious complications,the technical success rate was 88.5%, and stents were inserted in 15 patients. The diameter of IVC was increased to （ 19.20 ± 6.21 ） cm, the IVC pressure and pressure gradient from IVC to right atrium decrosed. Recurrent were found in 3 cases during 1-5as following-up. Conclusions Interventional therapy is a safe and effective procedure for segmental total occlusion of the retrohepatic IVC in BCS, using combining puncture techniquesand choosing proper balloon can increase the success rate and reduce the complications.