Budd-Chiari综合征介入治疗并发心脏压塞的分析和处理

Pericardial tamponade complicated by interventional management for Budd-Chiari syndrome: clinical analysis and treatment

目的探讨Budd-Chiari综合征(BCS)介入治疗并发心脏压塞的原因和处理方法。方法回顾性分析1990-2006年812例行BCS介入治疗中并发心脏压塞的9例患者的造影结果、临床症状、发生原因、处理方法和转归。结果 9例发生心脏压塞患者中,8例成功救治,1例死亡。其中下腔静脉阻塞型7例,肝静脉阻塞型1例,混合型1例。单纯误穿心包5例,误穿加球囊撕裂心包3例,支架移位进入右心房损伤心包1例。行传统心包穿刺抽液1例,外科手术处理3例,行剑突下Seldinger技术置管引流2例,观察、保守处理1例,经误入导管抽液1例,经误入导管抽液加剑突下Seldinger技术置管引流1例。结论心脏压塞是BCS介入治疗中少见且严重的并发症,术前预防、及时发现、合理处理是避免严重后果的关键。

Objective To discuss the causes and treatment of pericardial tamponade（PT） occurred in the interventional management for Budd-Chiari syndrome（BCS）.Methods During the period from 1990 to 2006,interventional treatment was performed in 812 patients with BCS.Pericardial tamponade occurred in nine patients during the period of interventional treatment.The clinical data,including angiographic findings,clinical symptoms,management and outcomes,of the nine patients were retrospectively analyzed.The possible causes of pericardial tamponade were discussed.Results Of the nine patients occurring pericardial tamponade,successful treatment was obtained in eight and death occurred in one.The lesions of BCS in the nine cases included inferior vena cava obstruction type（n = 7）,hepatic venous obstruction type（n = 1） and mixed type（n = 1）.Pericardial tamponade was caused by mistakenly puncturing into pericardium（n = 5）,mistakenly puncturing together with laceration of pericardium by balloon（n = 3）,and breaking of pericardium by displaced stent（n = 1）.Conventional pericardiocentesis was employed in one case,surgery was carried out in three cases,and infra-xiphoid catheterization and drainage using Seldinger technique was performed in two cases.Conservative treatment was adopted in one case and aspiration through the wrongly inserted catheter was tried in one case.In the remaining one case,aspiration through the wrongly inserted catheter together with infra-xiphoid catheterization and drainage by using Seldinger technique was carried out.Conclusion The pericardial tamponade is an severe complication occurred in the interventional management for Budd-Chiari syndrome,although it is rarely seen.Preoperative prevention,prompt detection and rational treatment are the keys to avoid serious consequences.