经皮腔内血管成形术治疗布加综合征

TREATMENT OF BUDD-CHIARI'S SYNDROME WITH PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (REPORT OF 13 CASES)

笔者采用经皮腔内血管成形术（PTA）治疗13例布加综合征（BCS）。男9例、女4例，平均39．9岁。其中下腔静脉（IVC）膜性阻塞10例，采用PTA单纯治疗；IVC节段性狭窄3例，采用PTA后置入自膨式金属内支架。术后IVC压力由术前3．77土0．79kPa即刻降至1．70士0．19kPa，IVC-右房压力阶差由2．58士0．73kPa降至0．18士0．12kPa。对其中12例随访3～44个月（平均18个月），主要临床症状和体征完全消失，仅首例膜性闭塞者PTA后44个月IVC发生再闭塞。笔者对介入治疗的临床价值、病例的选择、内支架的适应症等进行了讨论。认为膜性阻塞应首选PTA；对于节段性狭窄合理的治疗方法是PTA后置入内支架可有效阻止再狭窄的发生。

13 cases of Budd-Chiari's syndrome treated by percutaneous transluminal angioplasty (PTA) were reported.Among the 13 cases,there were 10 cases of membranous obstruction of inferior vena cava(IVC) only treated with PTA by using balloon catheters, 3 cases of segmental stenosis of hepatic segment of IVC treated by PTA and placement of stent. IVC pressure dropped from 3. 77± 0. 79 kpa to 1. 70± 0. 19 kpa,and the pressure gradient across obstrctive portion from 2. 58± 0. 73 kpa to 0. 18 ±0. 12 kpa after the procedure. 12 cases were followed up for an average of 18 months (range 3-44 months). The main symptoms and physical signs disappeared. Only one case of memebranous obstruction developed reocclusion after 44 months. The clinical value of interventional therapy and case selection were discussed. The results suggested that PTA should be the first choice in the treatment of membranous obstruction of IVC, and PTA followed by steming should be an effective therapeutic procedure for segmental stenotic Budd-Chiari's syndome.