经皮肝穿刺联合上下腔静脉途径介入治疗肝静脉闭塞型布加综合征

Interventional therapy of percutaneous transhepatic puncture combined with superior/inferior vena cava approach for BuddChiari syndrome caused by hepatic venous outflow obstruction

目的：评价肝静脉闭塞型布加综合征（BCS）介入治疗效果。方法：回顾性分析2010年1月—2016年1月于海南省人民医院血管外科接受介入治疗的14例肝静脉闭塞型BCS患者的临床资料。结果：14例患者手术方式均采用经皮肝穿刺造影结合上下腔静脉会师造影与球囊扩张术，14例患者均成功开通。患者均行逐步扩大直径的多次球囊扩张，其中9例患者半年内行2次手术，5例患者行3次手术。与术前比较术后患者平均肝静脉内压力明显降低（54cmH2Ovs.25cmH2O）；14例患者均未植入支架，所有患者症状均得到明显改善。随访时间为12~48个月，无死亡患者，无1例复发及严重并发症。结论：经皮肝穿刺造影结合上下腔静脉会师造影与球囊扩张术治疗肝静脉闭塞型BCS安全而有效，并发症发生率低，疗效满意。

Objective：To evaluate the effcacy of interventional therapy for Budd-Chiari syndrome （BCS） caused by hepatic venous outlfow obstruction. Methods：The clinical data of 14 patients with BCS due to hepatic venous outflow obstruction treated in Department of Vascular Surgery, Hainan Provincial People’s Hospital during January 2010 to January 2016 were retrospectively analyzed. Results：All the 14 patients were treated by percutaneous transhepatic angiography combined with superior/inferior vena cava two-way angiography and balloon dilatation, and recanalization was successful in all of them.All patients underwent repeat dilatation with increasing balloon diameter and of them, 9 cases had two and 5 cases had 3 dilatations during half a year. The average hepatic venous pressure of the patients was decreased obviously after the operations （preoperative value：54 cmH2O;postoperative value：25 cmH2O）, no stent was inserted in any of the patients and the symptoms in all of them were significantly relieved. Followed-up was conducted for 12 to 48 months, no death occurred and no recurrence or severe postoperative complications were found. Conclusion：For BCS secondary to hepatic venous outlfow obstruction, percutaneous transhepatic angiography combined with superior/inferior vena cava two-way angiography and balloon dilatation is a safe and effective treatment method, with low incidence of complications and satisfactory results.