布-加综合征的介入或半介入治疗

Interventional or semi-interventional treatment for Budd-Chiari Syndrome

目的 探讨布 加综合征的介入或半介入治疗方法。方法 自 1986年起 ,我们采用多种介入或半介入方法治疗该病 173例 :①下腔静脉PTA76例 ;②下腔静脉PTA加支架置放术 5 9例 ;③经皮经肝静脉再通术 3例 ;④下腔静脉置管溶栓 4例 ;⑤经右心房及股静脉联合破膜、扩张2 2例 ;⑥联合破膜、扩张加支架置入术 17例 ;⑦根治术加支架置放 3例 ;⑧下腔静脉单纯介入治疗后附加其它手术 2 3例。结果 介入治疗即时技术成功率 90 .1% ,半介入治疗技术成功率 10 0 %。治疗前后下腔静脉压力下降范围为 3～ 2 9cmH2 O。发生并发症者 8例。死亡 5例。随访结果 ,下腔静脉单纯PTA后复发率 14.5 % ,下腔静脉PTA加支架置放组复发率仅 1.7% ,联合破膜组复发率18.2 % ,其余各组尚未发现复发。结论 ①下腔静脉或肝静脉膜性阻塞或狭窄且无继发新鲜血栓者 ,PTA应为首选疗法。②下腔静脉破膜、扩张后出现弹性回缩者 ,应放置支架。③对于破膜困难者 ,应改行经右心房和股静脉联合破膜术。④下腔静脉病变合并肝静脉闭塞者 ,行下腔静脉介入治疗后可附加降低门脉高压的手术。

Objective To explore the interventional or semi interventional treatment for Budd Chiari syndrome.Methods From 1986, interventional or semi interventional treatments were applied to treat 173 cases of Budd Chiari syndrome. The treatments included: percutaneous transinferior vena cava angioplasty(PTA) (76), inferior vena cava (IVC) PTA with stent (59), percutanous transhepatic vein recanalization (3), IVC thrombosis through a catheter (4), combined transcardiac and transfemoral venous membranotomy and balloon dilation (22), combined transcardiac and transfemoral venous membranotomy and balloon dilation and stent (17), stenting during radical surgery (3), additional operation after intervention (23).Results The immediate technique successful rate for intervention was 90.1% , for the semi intervention 100%. The IVC pressure was reduced from 3 to 29 cmH 2O. Complication occurred in 8 cases. The death rate was 2.9% . A follow up study showed the recurrence rate was 14.5% in IVC PTA group, 1.7% in IVC PTA with stent group, 18.2% in combined technique without stent and no recurrence was found in the other groups.Conclusions The PTA is the first choice for localized lesions. When elastic recoil occurs, immediate stenting is suggested. The semi interventional approach is advised for PTA failure and more complicated cases. For those with both IVC lesion and occlusion of HV, the additional operation is needed after IVC intervention.