布加综合征疑难病例与介入治疗相关并发症的处理(附1859例报道)

Treatments to Deal with Difficult Cases and Complications During Interventional Therapy for Budd-Chiari Syndrome:Report of 1859 Cases

目的总结布加综合征行介入治疗过程中的疑难病例与介入治疗相关并发症的类型,提出相应的解决对策。方法回顾性分析1990年1月至2014年9月期间于笔者所在医院行介入诊断和治疗的1859例（2214例次）布加综合征患者的临床资料。结果本组患者在介入治疗过程中,发生与手术操作有关的并发症31例次,发生率为1.40%（31/2214）,其中成功处理并发症25例次,成功率为80.65%（25/31）。途中放弃治疗7例,术中和术后死亡6例,死亡率为0.32%（6/1852）。396例次疑难病例中,9例次未予处理、随访观察,余387例次中成功施行介入手术372例次,成功率为96.12%（372/387）。术后获访1553例,随访时间为10-284个月,平均100.9个月。获访病例中发生再狭窄209例,再狭窄发生率为13.46%（209/1553）。结论布加综合征的介入治疗已经进入成熟阶段,及时发现和正确处理术中并发症是提高介入治疗疗效和成功率的重要环节。

Objective To summarize the types of difficult cases and complications during interventional therapy for Budd-Chiari syndrome, and to propose solutions to these problems and complications. Methods Clinical data of 1859 cases of Budd-Chiari syndrome （2214 times） who underwent interventional diagnosis and therapy from Jan. 1990 to Sep. 2014 in our hospital were retrospectively analyzed. Results Of the 2214 times, complications happened in 31 times, which were related to the interventional therapy, and the incidence of complication was 1.40% （31/2214）. Of the 31 times who suffered from complications, 25 times were successfully treated, and the successful rate was 80. 65%. Three hundreds and seventy two times had been successful treated in 396 times with difficult situation （there were 9 times without treatment）, and the successful rate was 96. 12% （372/387）. Seven patients abandoned inteventional therapy. Six cases died during the operation and hospital stay period, and the mortality was 0. 32% （6/1852）. There were 1553 cases were followed-up for 10-284 months （average of 100. 9 months）. During the follow-up period, 209 cases suffered from restenosis, and the restenosis rate was 13.46% （209/1553）. Conclusion Interventional therapy for Budd-Chiari syndrome has entered a mature stage, discover timely and correct handling of intraoperative complications are important to improve the successful rate and curative effect.