经肝静脉交通支行肝静脉成形术治疗肝静脉阻塞布加综合征的安全性和疗效评价

Evaluation of the safety and efficacy of hepatic vein recanalization via intrahepatic collateral pathways in the treatment of Budd-Chiari syndrome with hepatic vein obstruction

目的探讨经肝静脉交通支行肝静脉成形术治疗肝静脉阻塞布加综合征(BCS)的安全性及疗效。方法选取我院收治的21例肝静脉阻塞BCS患者资料,全部患者均经肝静脉交通支行肝静脉成形术,测量介入治疗前后肝静脉-下腔静脉压力,并观察术后疗效和并发症,术后1、3、6、12个月及以后每年采用彩色多普勒超声进行随访,观察血管通畅情况。治疗前后肝静脉-下腔静脉压差比较采用配对t检验。结果21例均成功经肝静脉交通支开通阻塞肝静脉,其中9例开通1支肝静脉,10例开通2支肝静脉,2例开通3支肝静脉。肝静脉-下腔静脉压差由术前平均(14.5±2.7)mmHg降至术后平均(6.7±1.3)mmHg(t=11.789;P<0.01)。术中及术后均未出现肝静脉破裂出血、心包填塞等并发症。21例术后随访8~31个月,平均(23.2±5.3)个月,其中3例发生肝静脉再阻塞。术后6、12、24个月首次累积通畅率分别为100%、95.2%和85.7%。结论经肝静脉交通支行肝静脉成形术治疗肝静脉阻塞BCS安全、有效,其近中期疗效可靠,为肝静脉阻塞的BCS患者提供了一种新的治疗途径。

Objective To evaluate the safety and efficacy of hepatic vein(HV)recanalization using intrahepatic collateral pathways in patients with Budd–Chiari syndrome(BCS)with HV obstruction.Methods Data from 21 BCS patients with HV obstruction treated at our hospital were analyzed.All patients underwent HV recanalization through intrahepatic collateral pathways.The pressure of HV and inferior vena cava was measured before and after treatment.The efficacy and complications were observed.Follow-up was performed at 1,3,6,and 12 months after treatment and annually thereafter,HV patency was assessed using color Doppler ultrasound.The pressure gradient of HV-inferior vena cava before and after treatment was compared with paired t test.Results All 21 patients achieved successful recanalization of the obstructed HVs through intrahepatic collateral pathways.Among the 21 patients,one HV was successfully recanalized in 9 patients,two HVs were successfully recanalized in 10 patients,and three HVs were successfully recanalized in 2 patients.The mean pressure gradient of HV-inferior vena cava decreased from(14.5±2.7)mmHg before treatment to(6.7±1.3)mmHg after treatment(t=11.789;P<0.01).There were no complications of HV rupture and pericardial tamponade during or after the treatment.Over the follow-up period of 8 to 31(mean 23.2±5.3)months after interventional treatment of the 21 patients,reocclusion of HV was found in 3 patients.The overall cumulative 6-,12-,and 24-month primary patency rates were 100%,95.2%,and 85.7%,respectively.Conclusion Interventional treatment of HV obstruction in BCS patients through intrahepatic collateral approaches is safe and effective,with reliable midterm efficacy,providing a new option for patients with HV obstruction in BCS.