肝静脉阻塞型布加综合征的腔内治疗

Endovascular treatment of Budd-Chiari syndrome with occlusion of hepatic veins

目的总结肝静脉阻塞型布加综合征（Budd—Chiarisyndrome，BCS）的腔内治疗经验。方法回顾性分析32例肝静脉阻塞型BCS的临床资料。分别行下腔静脉球囊扩张成形或支架植入术＋脾肾静脉分流术；经股静脉或颈静脉入路肝静脉成形术和经皮肝穿刺肝静脉联合颈静脉和／或股静脉入路肝静脉成形术或支架植入术。结果2例行经皮肝穿刺肝静脉造影时未发现主肝静脉而放弃治疗，其余病例均成功行肝静脉成形和下腔静脉成形术。肝静脉扩张成形前后测肝静脉压力由术前（43±8）cmH20降至术后（16±4）cmH20（t=21．23，P〈0．01）。术后1周原有症状明显缓解，腹水消失，腹胀减轻，胸腹壁曲张静脉塌陷。围手术期发生2例穿刺针道出血，经剖腹止血后痊愈。本组随访25例，随访率78．1％。随访时间5—65个月，平均（26．0±2．0）个月。无支架移位及肝静脉再狭窄或闭塞，胸腹壁曲张静脉消失，食道造影见食道静脉曲张明显减轻。本组无肺栓塞及死亡病例。结论腔内治疗肝静脉阻塞型BCS方法简便、微创、有效，远期疗效尚有待于进一步观察研究。

Objective To evaluate endovascular treatment of Budd-Chiari syndrome （BCS）with occlusion of hepatic veins. Methods Retrospective analysis on the clinical materials of 32 BCS cases with occlusion of hepatic veins was made. Four cases received inferior vena cava （IVC） angioplasty or stent implant and splenorenal shunt; Transfemoral vein or transjugular hepatic vein angioplasty was performed in 10 cases, and percutaneous transhepatie recanalization combined with transjugular and/or transfemoral vein angioplasty of hepatic veins was performed in 16 cases, respectively. Two cases failed therapy attempt. Results A failure to find the main hepatic vein in percutaneous transhepatie venography lead to the abandent of therapy in 2 cases. Hepatic vein angioplasty and IVC angioplasty was successful in the other 30 cases. The pressure of hepatic vein decreased from （43 _± 8 ） cm H20 to （16 ± 4） cm H2 0 （t = 21.23, P 〈 0. 01 ）. The symptoms were obviously relieved, ascites disappeared, abdominal distension palliated, chest and abdominal wall varicose veins collapsed one week after endovascular treatment. During perioperative procedure, 2 cases with liver puncture bleeding were cured by laparotomy. The follow-up duration was 5 months to 65 months and mean （ 26. 0 ± 2. 0 ） months. There was no stent migration and hepatic vein restenosis and occlusion. Chest and abdominal wall varicose veins disappeared and esophagus phlebeurysma were ameliorated as shown by esophageal barium series. There were no puhnonary embolism and death. Conclusions The procedure of endovascular treatment of BCS with occlusion of hepatic veins is simple, mini-traumatic and effective.