Budd-Chiari综合征介入治疗并发心包填塞的外科及腔内治疗

Surgical and endovascular treatment of cardiac tamponade during the interventional management of Budd-Chiari syndrome

目的探讨Budd-Chiari综合征（BCS）介入治疗中并发心包填塞的外科及腔内治疗的可行性及其预防方法。方法回顾性分析7例BCS患者行介入治疗时发生急、慢性心包填塞的临床资料。全组均行心包穿刺引流,其中3例联合行心包切开减压及下腔静脉破口修补术,1例联合行腔内支架人工血管植入术。结果除1例因误诊为急性右心功能不全而死于多脏器功能不全综合征外,其它患者均治愈。2例单纯心包引流患者术后1个月再次行介入治疗治愈Budd-Chiari综合征。随访12-30个月,平均18个月,患者无不适及双下肢无水肿;超声提示心包腔内无积液,无腹水,肝静脉、下腔静脉通畅。结论心包填塞是BCS介入治疗中的严重并发症,一旦发生心包填塞,外科手术和/或腔内治疗可挽救患者生命,同时多学科的有效合作是治疗成功的重要保障。

Objective To explore the prevention and feasibility of surgical and endovascular treatment of cardiac tamponade in or after the interventional management of Budd-Chiari syndrome（BCS）.Methods The clinical data of 7 BCS patients who developed acute or delayed cardiac tamponade during the interventional procedure were retrospectively analyzed.Pericardiocenteses were performed in all patients,of which 3 cases also underwent surgical decompression of the pericardium and repair of rupture of the inferior vena cava,and 1 case underwent endovascular stent-graft implantation.Results All patients were cured except one who died of multiple organ dysfunction syndrome due to misdiagnosis as acute right heart failure.Two patients undergoing pericardiocentesis received a second BCS interventional therapy 1 month later and were cured.The patients were followed up for 12 to 30 months with average of 18 months.All patients had no discomfort or lower extremities edema.No cardiac effusion or ascites was detected,and the hepatic veins and inferior vena cava were patent under ultrasound.Conclusions Cardiac tamponade is a severe complication of BCS interventional therapy.Once it has occurred,emergent surgical or endovascular treatment could save the patient′s life.Meanwile,an effective multidisciplinary cooperation is the important assurance of success.