副肝静脉在布加综合征患者介入治疗中的意义

Significance of an accessory hepatic vein in the interventional treatment of Budd-Chiari syndrome

目的探讨副肝静脉在布加综合征（BCS）患者介入治疗中的意义。方法将2011年3月至2013年6月我科35例存在副肝静脉的BCS患者根据其是否梗阻分为2组。其中副肝静脉通畅组21例，病变特点为下腔静脉伴三支肝静脉梗阻，副肝静脉粗大、通畅；副肝静脉梗阻组14例，病变特点为副肝静脉及三支肝静脉梗阻，其中下腔静脉通畅13例，下腔静脉梗阻1例。在治疗过程中，副肝静脉通畅组患者行下腔静脉球囊扩张术（或支架置入术）；副肝静脉梗阻组患者行副肝静脉球囊扩张术（或支架置人术），1例合并下腔静脉梗阻的患者先行下腔静脉球囊扩张术。结果所有患者均一次性治疗成功，未出现治疗相关并发症。副肝静脉通畅组21例副肝静脉压力由术前的（28．81±6．23）cmH2O（1cmH2O=0．098kPa）降至治疗后的平均（18．62±5．06）cmH2O（P〈0．01）；血清总胆红素由治疗前的（23．24±6．41）μmol／L降至治疗后的（19．52±4．31）μmol／L（P〈0．01）；血清白蛋白治疗前（33．76±3．74）g／L，治疗后（34．05±3．62）g／L（P=0．485）。副肝静脉梗阻组副肝静脉压力由术前的（36．29±11．65）cmH2O降至治疗后的（22．07±7．67）cmH2O（P〈0．01）；血清总胆红素由治疗前的（31．24±9．54）μmol／L降至治疗后的（20．93±7．26）μmol／L（P〈0．01）；血清白蛋白治疗前（32．14±4．55）g／L，治疗后（32．11±4．47）g/L（P=0．861）。经随访，副肝静脉通畅组患者无症状复发。副肝静脉梗阻组中1例于治疗后5个月症状复发，再次给予副肝静脉球囊扩张术。结论对于下腔静脉伴三支肝静脉狭窄或闭塞的患者，若副肝静脉代偿性增粗、通畅，术中仅需处理下腔静脉即可。对于副肝静脉伴三支肝静脉狭窄或闭塞的患者，若副肝静脉代偿性增粗、扩张，开通副肝静脉是安全、有效的治疗途径。

Objective To investigate the significance of an accessory hepatic vein （AHV） in the interventional treatment of Budd-Chiari syndrome （BCS）. Methods From Mar. 2011 to Jun. 2013, 35 patients with BCS who also had an AHV were included into this study. The patients were divided into two groups according to whether the AHV was obstructive： 21 patients had obstruction to the inferior vena eava （IVC） and to the 3 hepatic veins （HV）, but the AHV was open; 14 patients had obstruction to the AHV and the 3 HVs. In 13 of these patients the IVC was open, but 1 patient had obstruction to the IVC. During treatment, the patients in the AHV open group underwent balloon dilation or stent insertion of IVC ; patients in the AHV obstruction group underwent balloon dilation or stent insertion of AHV. The patient with obstruction to the IVC underwent balloon dilation of IVC first. Results All patients were successfully treated with- out any procedure-related complications. In the AHV open group, the average pressure of the AHV decreased from （28.81±6. 23） cmH2O （1 cmH2O=0. 098 kPa） before treatment to （18.62±5.06） cmH2O after treatment （P 〈0. 01 ） ; the average serum TBIL decreased from （23.24 ±6.41 ） μmol/L before treatment to （ 19. 52 ± 4. 31 ） μmol/L after treatment （ P 〈 0. 01 ） ; the average serum albumin changed from （ 33.76 ±3.74） g/L before treatment to （ 34.05 ±3.62） g/L after treatment （ P = 0. 485 ）. In the AHV obstruction group, the average pressure of the AHV decreased from （ 36.29 ±11.65 ） cmH2O before treatment to （22. 07±7. 67） cmH2O after treatment （P 〈0. 01 ） ; the average serum TBIL decreased from （31.24 ±9. 54） μmol/L before treatment to （20.93 ±7.26） p, mol/L after treatment （P 〈0.01 ） ; the average serum albumin changed from （ 32. 14 ± 4. 55 ） g/L before treatment to （ 32. 11 ± 4.47 ） g/L after treatment （P =0. 861 ）. During follow-up, no patients experienced recurrence of symptoms in the AHV open group; one patient experienced recurrence of symptoms 5 months after treatment in the AHV obstruction group. This patient received a second balloon dilation of the AHV. Conclusions For patients with BCS with IVC and the 3 HVs obstruction, if the AHV was open, we could only treat the IVC. For patients with BCS with AHV and the 3 HVs obstruction, AHV dilation followed by recanalization of AHV was also effective.