腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用

Application of endovascular catheter-stirring thrombolysis in Budd-Chiari syndrome combined with inferior vena cava and hepatic vein thromboses

目的 分析腔内导管搅拌溶栓治疗伴下腔静脉及肝静脉新鲜血栓的布-加综合征(BCS)的安全性和有效性。方法 回顾分析我院22例BCS伴下腔静脉及肝静脉新鲜血栓患者的临床资料,患者均接受经导管搅栓溶栓、血栓抽吸及经皮血管成形术等腔内介入治疗。统计患者治疗后血栓清除及并发症发生情况。结果 21例患者下腔静脉及肝静脉新鲜血栓完全清除,1例患者溶栓后消化道出血,终止治疗,且随访期间失访。22例患者围术期均未出现肺栓塞症状。随访期间,21例患者下腔静脉及肝静脉血流通畅,无血栓形成、明显狭窄及肺动脉栓塞发生,患者临床症状及体征完全消失,11例植入支架的患者支架无明显移位或断裂。结论 腔内导管搅拌溶栓治疗BCS合并下腔静脉及肝静脉新鲜血栓安全有效,可有效清除下腔静脉及肝静脉新鲜血栓,避免肺动脉栓塞的发生。

Objective To explore the safety and efficacy of endovascular catheter-stirring thrombolysis in the treatment of Budd-Chiari syndrome(BCS) with fresh thrombi in the inferior vena cava and hepatic vein.Methods The clinical data of 22 patients with BCS and fresh thrombi in the inferior vena cava and hepatic vein were retrospectively analyzed,and all patients received endovascular interventions including catheter-stirring thrombolysis,thrombi aspiration and percutaneous transluminal angioplasty.The clearance of thrombi and occurrence of complications after operation were collected.Results The fresh thrombi in the inferior vena cava and hepatic vein for 21 patients were completely cleared,and 1 patient terminated the treatment for gastrointestinal bleeding after thrombolysis,and was lost to follow-up.There was no perioperative pulmonary embolism in 22 patients.During the follow-up,the inferior vena cava and hepatic vein of 21 patients had smooth blood flow and without thrombosis,obvious stenosis or pulmonary embolism,and the clinical symptoms and signs of the patients completely disappeared;and 11 patients who underwent stenting had no significant displacement or rupture of the stents.Conclusion Endovascular catheter-stirring thrombolysis in the treatment of BCS combined with fresh thrombi in the inferior vena cava and hepatic vein is safe and effective,which can clear the fresh thrombi in the inferior vena cava and hepatic veins effectively and avoid the occurrence of pulmonary embolism.