介入治疗布加综合征合并肝静脉血栓的远期疗效

Long-term efficacy of interventional treatment for Budd-Chiari syndrome with hepatic vein thrombosis

目的探讨介入治疗布加综合征(BCS)合并肝静脉血栓(HVT)的远期疗效。方法选取39例BCS合并HVT患者的临床资料。所有患者经彩色多普勒超声、DSA及导管血栓抽吸检查确诊为BCS合并HVT,采用小球囊预扩张、经导管溶栓、肝静脉球囊扩张和(或)支架置入治疗。术后1、3、6、12个月及此后每年采用彩色多普勒超声或MRA进行随访,使用Kaplan-Meier曲线评估肝静脉首次累积通畅率及生存率。结果39例患者中,血栓完全溶解28例,部分溶解11例,溶栓时间3~11 d,平均(5.3±3.8)d。39例均成功开通肝静脉,其中单纯球囊扩张26例,支架置入13例。无出血、肺栓塞等并发症发生。39例随访6~154个月,平均(82.2±43.4)个月,无血栓复发,肝静脉再闭塞14例,均再次球囊扩张治疗成功。1、3、5、10年肝静脉首次累积通畅率分别为79.5%、70.9%、60.19%和60.1%。7例患者死亡。1、3、5、10年累积生存率分别为97.4%、94.9%、87.2%、82.1%。结论介入治疗BCS合并HVT可获得较好的远期疗效,但部分患者仍面临再闭塞风险,需要加强随访和管理。

Objective To evaluate the long-term efficacy of interventional treatment for Budd Chiari syndrome(BCS)with hepatic vein thrombosis(HVT).Methods The clinical data of 39 BCS patients with HVT were selected.All 39 BCS patients with HVT were diagnosed through color Doppler ultrasound,DSA and transcatheter thrombus aspiration.Small balloon predilation,transcatheter thrombolysis,balloon dilation and/or stent placement of hepatic vein were performed for treatment.Followup was performed by color Doppler ultrasound or MRA at 1,3,6,and 12 months after treatment,and annually thereafter.The cumulative primary patency rate of hepatic veins and the cumulative survival rate of patients were evaluated with Kaplan-Meier curves.Results Complete or partial thrombus dissolution was accomplished in 28 and 11 cases,respectively.The retaining time of transcatheter thrombolysis was 3-11(mean 5.3±3.8)days.All 39 patients achieved successful recanalization of the obstructed HV.Among these patients,26 cases underwent balloon dilation and 13 cases underwent stent placement.No complications of bleeding or pulmonary embolism occurred.Thirty-nine patients were followed up for 6-154(mean 82.2±43.4)months.There were no cases of thrombus recurrence.Fourteen cases experienced hepatic vein re-occlusion,which were successfully treated with balloon dilation.The cumulative 1,3,5,and 10 year primary hepatic vein patency rates were 79.5%,70.9%,60.19%,and 60.1%,revealed vascular.Seven patients died.The cumulative 1,3,5,and 10 year survival rates were 97.4%,94.9%,87.2%,and 82.1%,respectively.Conclusion Interventional treatment of BCS with HVT can achieve good long-term efficacy,but some patients still face the risk of re-occlusion and need to be closely followed up and managed.