Budd-Chiari综合征合并血栓形成的介入治疗

Interventional therapy of Budd Chiari syndrome complicated with thrombosis

目的 探讨Budd Chiari综合征 (BCS)合并血栓形成的介入治疗方法。方法 18例BCS合并血栓形成的患者 ,2例为肝静脉阻塞合并血栓形成 ,16例为下腔静脉阻塞合并血栓形成。采用术前抗凝 (复方丹参和阿司匹林 )或抗凝 +尿激酶溶栓治疗 ,术中分次球囊扩张 +支架压迫 ,术后尿激酶溶栓 +抗凝治疗。结果 18例BCS合并血栓形成的患者皆成功地实施了介入开通术 ,未发生严重并发症。术后下腔静脉压力由 (31 82± 0 5 2 )cmH2 O(1cmH2 O =0 0 98kPa)下降到 (18 17± 0 38)cmH2 O。 2例肝静脉压力术前分别为 :42、41cmH2 O ,术后分别为 :15、16cmH2 O。随访 6个月至 6年 (平均 38个月 ) ,12例临床症状和体征完全消失 ,6例明显改善。结论 介入治疗BCS合并血栓形成是一种安全。

Objective To study the interventional therapeutic methods in Budd Chiari syndrome (BCS) complicated with thrombosis. Methods Eighteen patients of BCS complicated with thrombosis, including 2 cases of hepatic vein (HV) occlusion and 16 cases of inferior vena cava (IVC) occlusion, were treated. Therapeutic methods were anti coagulation with Co Danshen and aspirin in 10 cases or the anti coagulation and thrombolysis with urokinase in 8 cases before operation, treatment with PTA and stent during operation,and thrombolysis with urokinase and the anti coagulation after operation. Results Technical success was achieved in all patients without serious complications. The mean blood pressure in IVC dropped from (31 82±0 52)cm H 2O(1 cm H 2O= 0 098 kPa) to (18 17±0 38)cm H 2O immediately after the procedure. The blood pressure in HV dropped from 42 cm H 2O and 41 cm H 2O to 15 cm H 2O and 16 cm H 2O, respectively. All 18 cases were followed up for an average of 38 months (range 6-72 months). The main symptoms and signs completely disappeared in 12 cases and partially alleviated in 6 cases. Conclusion The interventional treatment of BCS complicated with thrombosis was a safe and effective method.