介入治疗Budd-Chiari综合征的效果观察

Clinical effect observation of intervention in the treatment of Budd Chiari syndrome

目的探讨介入治疗Budd-Chiari综合征的临床效果。方法选择2008年1月～2012年12月Budd-Chiari综合征患者33例,不同类型Budd-Chiari综合征采用的不同介入治疗方法,观察介入治疗前、治疗后7 d、治疗后30 d下腔静脉压力、肝脾形态及门静脉、脾动静脉及肝动脉右前支血流动力学指标的变化情况。结果介入治疗后下腔静脉压力、狭窄两端压力差[(13.89±2.94)、(1.73±0.23)mm Hg]较术前[(20.67±5.82)、(8.18±1.62)mm Hg]明显降低,而介入治疗后下腔静脉直径[(2.53±0.58)cm]较治疗前[(0.59±0.23)cm]明显增加,差异均有统计学意义(P<0.05或P<0.01)。治疗后30 d肝右叶最大斜径[(12.0±1.7)cm]、尾叶最大斜径[(7.0±0.6)cm]、脾脏最大斜径[(11.0±0.9)cm]均较治疗前[(15.8±1.6)、(8.1±1.3)、(14.5±2.6)cm]明显缩小,差异均有统计学意义(均P<0.05)。治疗后30 d门静脉流速[(18.4±2.3)cm/s]及肝动脉右前支峰值流速[(56.3±6.2)cm/s]均较治疗前[(15.8±2.6)、(46.5±7.3)cm/s]明显增加,而治疗后30 d脾静脉流速[(10.3±2.6)cm/s]较治疗前[(15.8±2.6)cm/s]明显降低,差异均有统计学意义(P<0.05)。结论应用介入方法治疗Budd-Chiari综合征成功率高,能明显改善腔静脉压力,使肝脾明显回缩,且明显改善血流动力学指标,是一种微创、恢复快、疗效显著且又安全的治疗方法,值得推广。

Objective To investigate the clinical effect of interventional methods in the treatment of Budd-Chiari syn- drome. Methods 33 patients with Budd-Chiari syndrome from January 2008 to December 2012 were selected as the object of study, and different interventional treatment methods were used in different types of Budd-Chiari syndrome; the changes of inferior vena cava pressure, liver and spleen morphology and portal vein, splenic vein and hepatic artery right anterior branch hemodynamic parameters changes before and 7, 30 days after interventional treatment were observed. Results Inferior vena cava pressure, narrow pressure difference on both ends after the interventional therapy [（13.89±2.94）, （1.73±0.23） mm Hg] were lower than those before the interventional therapy [（20.67±5.82）, （8.18± 1.62） mm Hg], inferior caval vein diameter after the interventional therapy [（2.53±0.58） cm] was higher than that before the interventional therapy [（0.59±0.23） cm], the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. Maximum oblique diameter of right liver lobe, maximum oblique diameter of eaudate lobe, maximum oblique diameter of spleen after the interventional therapy [（12.0±1.7）, （7.0±0.6）, （11.0±0.9） cm] were smaller than those before the in- terventional therapy [（15.8±1.6）, （8.1±1.3）, （14.5±2.6） cm], the differences were statistically significant （P 〈 0.05）. Portal vein velocity, right hepatic artery peak flow velocity 30 days after the interventional therapy [（18.4±2.3）, （56.3±.2） cm/s] were higher than those before the interventional therapy [（15.8±2.6）, （46.5±.3） cm/s], splenic venous flow velocity 30 days after the interventional therapy [（10.3±2.6） cm/s] was lower than before the interventional therapy [（15.8± 2.6） cm/s], the differences were statistically significant （P 〈 0.05）. Conclusion Interventional treatment for Budd- Chiari syndrome has high success rate, can significantly improve the pressure on the vena eava, make the liver and spleen apparent retraction, and significant improve hemodynamie parameters. It is a minimally invasive method and has quick recovery, the effect is significant. It is a safe treatment method and is worthy of promotion and application.