下腔静脉梗阻型Budd-Chiari综合征的介入治疗

Interventional Therapy in the Budd-Chiari Syndrome Patients with Inferior Vena Cava Obstruction

目的探讨腔内血管成形术在下腔静脉(IVC)梗阻型Budd-Chiari综合征(BCS)治疗中的应用价值。方法回顾性分析35例接受介入治疗的IVC梗阻型BCS患者的临床及随访资料,根据IVC病变类型采取不同的介入治疗方法。对比IVC开通前后压力、临床表现及实验室指标情况,对全组患者的IVC血管通畅率进行中远期随访。结果 35例患者均介入治疗成功,其中单纯球囊扩张12例,球囊扩张联合支架置入23例,术中未出现血压下降、腹膜刺激征、腹腔出血、心包填塞等严重并发症。IVC开通后压力显著下降,由术前(35.03±6.32) cm H2O降低至术后(21.46±4.14) cm H2O,差异具有统计学意义(t=11.666,P=0.000)。与术前比较,术后1个月时患者症状、体征、实验室指标均出现显著改善。随访时间2~62个月,中位随访时间26个月。患者1,3,5年IVC血管通畅率分别为97.1%,83.1%,75.6%,其中单纯球囊扩张组为91.7%,66.8%,53.5%,联合支架置入组为100.0%,95.2%,95.2%。5例患者IVC梗阻复发,再次介入治疗后通畅。结论介入治疗IVC梗阻型BCS近期疗效确切,中远期血管通畅率较好,值得临床推广应用。

Objective To explore the application value of interventional angioplasty in the Budd-Chiari syndrome(BCS)patients with inferior vena cava(IVC)obstruction.Methods Clinical and follow-up information of 35 patients with IVC obstruction-type BCS treated with interventional therapy was retrospectively collected.Patients were treated with different interventional therapies according to their different lesion types.Results A total of 35 patients were treated successfully with interventional therapy,including 12 cases of simple balloon dilatation and 23 cases of balloon dilatation combined with stent placement.During the operation,no patient experienced serious complications,such as drop of blood pressure,peritoneal irritation sign,intra-abdominal hemorrhage,pericardial tamponade,and so on.After the operation,IVC pressure decreased drastically from(35.03±6.32)cm H2O to(21.46±4.14)cm H2O(t=11.666,P=0.000).Compared with pre-operative status,symptoms,signs,laboratory indicators one month after surgery had all remarkably improved.Patients were followed up for 2~62 months,with median follow-up time of 26 months.The 1-,3-,5-years IVC patency after first treatment were 97.1%,83.1%,75.6%in all patients,and were 91.7%,66.8%,53.5%and100.0%,95.2%,95.2%in the balloon dilatation group and stent placement group,respectively.A total of 5 patients underwent IVC reocclusion,and patency was re-established with angioplasty.Conclusion IVC angioplasty for BCS with IVC-obstruction is worthy of promotion and application,due to definite short-term positive outcome and decent mid-long-term IVC patency.