经皮腔内血管成形术治疗布-加综合征长期疗效观察

Observation on long-term effects of pereutaneous transluminal angioplasty in treating Budd-Chiari syndrome

目的 探讨经皮腔内血管成形术治疗布-加综合征的安全性、有效性并分析长期随访结果 .方法 对1998年10月至2008年5月98例成功接受经皮腔内血管成形术治疗的布-加综合征患者（下腔静脉阻塞型34例、肝静脉阻塞型22例、混合型42例）进行研究,观察术后临床表现及肝功能变化情况,评估患者的长期生存情况.结果 仅2例患者并发穿刺道出血,经急诊外科手术治疗后预后良好.60例下肢水肿患者术后水肿完全消失.88例腹水患者中80例术后腹水消失,8例术后再予口服利尿剂治疗后腹水消失.术后1个月和末次随访时的中位Rotterdam预后指数分别为0.11和0.09,均较术前（1.12）降低,差异有统计学意义（P值均为0.000）.术后1、3、5年的累积血管通畅率分别为96%、94%、94%,累积生存率分别为94%、91%、87%.结论 经皮腔内血管成形术治疗布-加综合征成功率较高,安全性和长期生存情况较好.

Objective To evaluate the safety and efficacy of percutaneous transluminal angioplasty （PTA） in treating Budd-Chiari syndrome （BCS） and to analyze the long-term follow-up results. Methods From October 1998 to May 2008,98 BCS patients （inferior vena cava obstruction,n = 34 ; hepatic vein obstruction, n = 22; combined obstruction, n = 42） who accepted PTA treatment successfully were investigated. The changes of clinical manifestations and liver function post-operation were observed; the long term survival rate was evaluated. Results Only two patients were complicated with transhepatic puncture tract bleeding, the prognosis was good after emergency operation. Sixty patients presented with low extremities edema, which was fully subsided after PTA.Of eighty-eight ascites patients, ascites disappeared in eighty patients after operation, and in the other eight patients combined with oral diuretic treatment post-operation. The median Rotterdam prognostic score of one month post-operation and the last follow-up time point was 0. 11 and 0. 09, significantly lowered than pre-operation （1.12）. The difference was statistical significance （P=0. 000）. At 1, 3, 5 years postoperative, the cumulative vessel patency rates were 96%, 94% and 94% respectively, and the cumulative survival rates were 94%, 91% and 87%. Conclusions Treating BCS with PTA has a high success rate, a good safety and a long-term survival rate.