布-加综合征的介入治疗

Interventional therapy on Budd-Chiari syndrome

目的探讨布-加综合征的介入治疗方法及疗效。方法采用Seldinger技术经右侧股静脉穿刺插管,先行下腔静脉造影。狭窄病例直接用导丝通过狭窄部位;闭塞病例同时作右侧颈静脉穿刺行下腔静脉闭塞段上下端会师造影,再采用导丝硬头破膜或用TIPS穿刺针或房间隔穿刺针穿过闭塞段。膜性狭窄或膜性闭塞病例,单纯采用球囊扩张治疗;节段狭窄或节段闭塞病例,采用球囊扩张加支架植入治疗。结果收治21例布-加综合征患者,其中肝静脉膜性闭塞1例,膜性狭窄1例;下腔静脉节段狭窄合并肝静脉膜性狭窄1例;下腔静脉膜性狭窄3例,节段狭窄2例;下腔静脉膜性闭塞6例,节段闭塞7例。19例手术成功,其中单纯球囊扩张12例,球囊扩张加支架植入7例。2例下腔静脉节段闭塞手术失败,其中1例用房间隔穿刺针穿刺入心包引起心包积血,处理好转后患者拒绝再次手术;1例患者单纯行下腔静脉造影10 d后再次造影见下腔静脉内充满血栓,行溶栓治疗后出院。结论布-加综合征类型复杂,根据不同类型采用不同方法行介入治疗,操作方便、安全,效果良好。

Objective To discuss the method and curative effects of interventional therapy on Budd-Chiari syndrome. Methods Catheterizing was carried out through the right femoral vein by Seldinger teehnology and inferior vena cavography was done. The stricture parts of the stenosis cases were directly punctured with the guide wire. The occlusion cases received rendezvous radiography on the both ends of the occluded segments and also the puncture of the right jugular vein at the same time. Then the rupture of the membrane was carried out with the guide wire head, or TIPS needles or interatrial septum puncture needles were used to get through the blocked section. Membranous stenosis or membranous occlusion cases were treated by simple sacculus dilation treatment. Segmental stenosis or segmental occlusion cases received the sacculus dilatation plus stent implantation. Results Among the 21 cases of Budd-Chiari syndrome, there were one case of hepatic vein membranous occlusion, one of membranous stenosis, one of inferior vena cava segmental stenosis complicated with hepatic vein membranous stenosis, three ones of inferior vena cava membranous stenosis, two of segmental stenosis, six ones of inferior vena cava membranous occlusion, and seven ones of segmental occlusion. Operations were successfully carried out in 19 cases in which 12 ones received simple saccule dilatation and 7 ones received saccule dilatation plus stent implantation. Two cases of IVC occlusion operation failed, including 1 case of hemopericardium caused by the puncture by interatrial septum needle, and the patient refused to receive another operation after the improvement. The other case underwent inferior vena cavography,but 10 days later angiography showed inferior vena cava was filled with thrombus. The patient discharged after the thrombolysis therapy. Conclusion The types of Budd-Chiari syndrome are complicated. Carrying out different ways of interventional therapy according to the different types has the advantages of simple operation, safety, and good effects.