置管溶栓联合血管腔内成形术治疗合并下腔或下肢静脉血栓的布加综合征

Transcatheter thrombolytic therapy combined with PTA and stent in the treatment of Budd-Chiari Syndrome patients complicated with thrombosis of inferior vena cava or lower limbs veins

目的探讨置管溶栓联合血管腔内成形术治疗合并下腔或下肢静脉血栓的布加综合征(BCS)的应用价值。方法全组29例BCS,造影发现下腔静脉(IVC)肝段上方狭窄或闭塞,同时伴有IVC血栓形成,部分伴有单侧或双侧下肢深静脉血栓。经腘静脉置管溶栓后,其中25例二期行血管腔内成形术。结果 18例血栓基本消失或明显缩小、管腔通畅,其中6例单纯行球囊扩张术,12例行球囊扩张加支架成形术;9例患者溶栓后陈旧性血栓范围仍然广泛,其中7例行腔内治疗后症状明显缓解。2例有明显出血倾向后停药,闭塞范围仍然广泛,无肺栓塞发生。25例随访2～62个月,平均31个月,21例临床症状和体征明显缓解,2例明显缓解后复发,2例未缓解,治疗总有效率为84.0%。结论腘静脉置管溶栓治疗BCS合并下腔或下肢静脉血栓的溶栓效果优于全身用药,溶栓后介入治疗微创,疗效好,可作为此类疾病的常规治疗。

Objective To evaluate the clinical application of transcatheter thrombolytic therapy combined with percutaneous transluminal angioplasty in the treatment of Budd-Chiari Syndrome complicated with inferior vena cava thrombosis or lower extremity venous thrombosis. Methods Stenosis and occlusion of supra-hepatic inferior vena cava （IVC） accompanied by inferior vena cava thrombosis, or accompanied by unilateral or bilateral lower extremity deep venous thrombosis, were detected by angiography in 29 patients. All patients received transcatheter thrombolytic therapy through popliteal vein, and 25 of them received secondary balloon angioplasty and stent implantation. Results After treatment, the thrombosis resolved or was markedly alleviated with patency of the vein in 18 cases, of which, 6 cases were simply treated with balloon angioplasty and 12 cases were treated with balloon angioplasty and stent implantation. However, after thrombolytic therapy,widespread old thrombosis was found in 9 cases, of which 7 cases were apparently alleviated after endovascular treatment. In 2 cases with significant bleeding tendency, the treatment was suspended, so the obstruction area was still extensive, but without pulmonary embolism. During an average follow-up of 31 months （range from 2 to 72 months）, 21 cases had apparent amelioration of clinical symptoms and signs, 2 cases relapsed after earlier apparent relief and 2 cases were not relieved. The overall effective rate was 84.0%. Conclusions Transcatheter thrombolytic therapy via popliteal vein for Budd-Chiari Syndrome complicated with thrombosis of inferior vena cava or the lower limbs veins is more effective than systemic thrombolytic administration, and the subsequent interventional therapy is minimally invasive and effective. So this method can be considered as routine treatment for such disorders.