改良式TIPS治疗肝静脉广泛阻塞型布-加综合征的近期疗效

Modified TIPS for the treatment of Budd-Chiari syndrome with extensive occlusion of hepatic veins:its short-term results

目的观察改良式TIPS治疗肝静脉广泛阻塞型布-加综合征(BCS)的近期疗效。方法 7例肝静脉广泛阻塞型BCS患者,使用改良术式TIPS治疗,其中2例为急性,5例为亚急性或慢性。术后给予正规抗凝治疗,并用彩色多普勒超声随访疗效。结果 7例肝静脉广泛阻塞型BCS均成功完成改良式TIPS,7例患者共置入12枚支架(覆膜支架3枚,自膨式支架9枚),随访彩色多普勒超声2～12个月,1例术后5个月又出现狭窄,并行第2次介入治疗,置入1枚支架。术后门脉压力由术前的(40.7±12.6)cmH2O下降到(17.2±3.4)cmH2O,术后1个月肝功能指标及脾功能亢进血象明显好转。结论改良式TIPS治疗肝静脉广泛阻塞型BCS近期疗效满意。

Objective To investigate the short-term clinical efficacy of modified TIPS for the treatment of Budd-Chiari syndrome（BCS） with extensive occlusion of hepatic vein.Methods Modified TIPS was carried out in seven patients of BCS with extensive occlusion of hepatic vein.Of the seven patients,acute development of BCS was seen in 2 and sub-acute or chronic onset of the disease in 5.Postoperative anticoagulation therapy was employed.Follow-up examination with color Doppler ultrasonography was conducted in all patients.The technical and clinical results were analyzed.Results Technical success was achieved in all seven patients.A total of 12 stents,including 3 covered-stents and 9 self-expanding stents,were implanted between portal vein and inferior vena cava in seven patients.During a following-up period of 2-12 months,color Doppler ultrasonography showed that re-stenosis developed in one patient after 5 months and interventional procedure had to be carried out once more to place an additional stent.After modified TIPS treatment,the portal pressure fell from（40.7 ± 12.6） cmH2O to（17.2 ± 3.4） cmH2O.One month after the treatment the liver functions,the blood counting related to hypersplenism were significantly improved.And the clinical condition took a turn for the better.Conclusion Carrying a satisfactory clinical short-term result,modified TIPS is an ideal and effective treatment for BCS accompanying extensive occlusion of hepatic vein.