肝静脉型布加综合征治疗中开通副肝静脉的临床价值评估

Effects of patent accessory hepatic vein in the treatment of Budd-Chiari syndrome with hepatic vein occlusion

目的评估肝静脉型布加综合征(BCS)中开通副肝静脉(AHV)的临床价值。方法回顾性分析2010年1月至2019年6月收治的21例主肝静脉(MHV)梗阻BCS患者的临床资料。结果21例患者均接受AHV成形术和(或)下腔静脉成形或溶栓术。造影提示AHV直径6~13 mm,AHV与下腔静脉(IVC)远心端角度为(106.9±27.7)°,AHV开口于IVC右侧者占57.1%,前壁9.5%,左侧壁1.4%。所有患者的技术成功率100%,13例行AHV球囊扩张者的AHV压力由术前的(41.6±6.4)cm H_(2)O(1 cm H_(2)O=0.098 kPa)降至术后的(22.2±5.5)cm H_(2)O,差异有统计学意义(t=11.966,P<0.01);IVC溶栓和球囊扩张后,AHV压力从(29.1±3.3)cm H_(2)O降至(19.1±8.8)cm H_(2)O(t=8.136,P<0.01),肝段IVC压力从(25.5±6.1)cm H_(2)O降至(13.8±4.0)cm H_(2)O(t=5.536,P<0.01)。术后6个月患者症状和肝功能均明显改善,血管超声提示AHV和IVC通畅。结论开通AHV有助于缓解肝静脉梗阻BCS患者的症状,改善肝内血流。

Objective To evaluate the clinical significance of patent accessory hepatic vein(AHV)in treatment of Budd-Chiari syndrome(BCS)with hepatic vein occlusion.Methods The clinical data of 21 BCS patients treated from Jan 2010 to June 2019 were retrospectively analyzed.All patients underwent AHV and IVC venography.Results Angiography showed that the diameter of AHV was 6-13mm after the procedure,the angle between AHV and the distal end of IVC was(106.9±27.7)°,and 57.1%of the AHV were opened at the right side of IVC,9.5%at the front,and 1.4%at the left side,respectively.The technical success rate was 100%.Thirteen patients with AHV disease underwent balloon dilatation angioplasty,and their preoperative AHV pressure dropped from(41.6±6.4)cm H_(2)O to(22.2±5.5)cm H_(2)O(t=11.966,P<0.01).The preoperative AHV and intrahepatic IVC pressure decreased from(29.1±3.3)cm H_(2)O to(19.1±8.8)cm H_(2)O(t=8.136,P<0.01)and from(25.5±6.1)cm H_(2)O to(13.8±4.0)cm H_(2)O(t=5.536,P<0.01),respectively.All patients were of no symptom during follow up for 6 months and ultrasound showed that the patency rate of original lesion was 100%.Conclusion A patent AHV helps alleviate the symptoms and blood congestion of BCS patients with hepatic vein obstruction.