采用介入方法治疗下腔静脉全程闭塞的安全性和疗效

Safety and efficacy of interventional treatment for occlusion of the entire inferior vena cava

目的 探讨下腔静脉全程闭塞介入治疗的安全性及疗效.方法 回顾性分析6例经彩色多普勒超声及DSA确诊的下腔静脉全程闭塞患者资料.全部患者均于局部麻醉下经颈静脉联合经股静脉途径行肝静脉、下腔静脉造影及球囊扩张和（或）支架置入术,测量介入治疗前后肝静脉-右心房压力差及下腔静脉-右心房压力差,并观察术后疗效和并发症.术后1、3、6、12个月及此后每间隔12个月行彩色多普勒超声随访,观察血管通畅情况.治疗前后肝静脉-右心房压力差及下腔静脉-右心房压力差的比较采用配对￡检验.结果 6例患者中,5例均成功开通1支肝静脉及下腔静脉；1例下腔静脉开通失败,仅开通肝右静脉.6例肝静脉-右心房压力差由术前的（23.2±2.0）cmH2O（1 cmH2O =0.098 kPa）降至术后的（8.7 ±3.2） cmH2O,5例下腔静脉-右心房压力差由术前的（26.6±2.7）cmH2O降至术后的（9.4±1.1） cmH2O,差异均有统计学意义（t值分别为21.6和16.1,P ＜0.05）.3例患者术后出现轻度刺激性腹痛,24 h内缓解,无出血、死亡等并发症.6例患者随访16 ～ 90个月,平均（42±27）个月,均无肝静脉再狭窄,5例患者下腔静脉均通畅,无再狭窄.结论 下腔静脉全程闭塞的介入治疗安全、有效.

Objective To evaluate the safety and efficacy of interventional treatment of occlusion of the entire inferior vena cava （IVC）.Methods The clinical data of 6 patients with entire IVC occlusion were analyzed retrospectively.All patients were diagnosed by color Doppler ultrasound and DSA.Venography was performed under local anesthesia via internal jugular vein and femoral vein approach.The occlusion of IVC and hepatic vein were treated with balloon dilatation and/or stent placement.Follow-up examination with color Doppler ultrasound was taken 1,3,6,12 months after treatment and annually thereafter to assess the patency of IVC and hepatic vein.The pressure gradient of hepatic vein-right atrium and IVC-right atrium before and after interventional treatment were compared with paired t test.Results In 5 cases,both IVC and 1 hepatic vein were recanalized successfully.In 1 case,recanalization of IVC failed,but the right hepatic vein was recanalized successfully.The mean pressure gradient of hepatic vein-right atrium decreased from （23.2 ± 2.0） cmH2O （1 cmH2O =0.098 kPa） before treatment to （8.7 ± 3.2） cmH2O after treatment in 6 cases （t =21.6,P 〈 0.05）.The mean pressure gradient of IVC-right atrium decreased from （26.6 ± 2.7） cmH2O before treatment to （9.4 ± 1.1） cmH2O after treatment （t =16.1,P 〈 0.05）.Abdominal pains occurred in 3 patients after stent implantation which disappeared in 24 hours.No other complications such as bleeding and death occurred.During a mean follow-up of（42 ± 27）months （16 to 90 months）,hepatic vein patency was maintained in 6 cases and IVC patency was maintained in 5 cases.Conclusion Interventional treatment of occlusion of the entire IVC is a safe and effective method.