自制改良式Z-stent在布-加综合征介入治疗中的应用

Application of modified Z-stent in interventional therapy of Budd-Chiari syndrome

目的 探讨自制改良式Z stent在治疗布 加综合征 (BCS)中的应用价值。方法 ①首先行彩色Doppler检查确定BCS病变性质以选择血管内支架类型 ;②X线监视下行下腔静脉破膜及扩张后 ,将作有标记的自制改良式Z stent准确置放于下腔静脉 ,其无支架区对准肝静脉开口 ;③行下腔静脉及肝静脉造影以了解支架位置。结果 应用自制改良式Z stent治疗 18例BCS病人 ,下腔静脉压力由术前 (2 8 5± 1 0 )cmH2 O降至术后 (8 6± 0 9)cmH2 O ,随访 5～ 38个月 ,肝静脉及下腔静脉血流通畅 ,症状及体征消失。结论 自制改良式Z stent能避免肝静脉开口受压并完全对抗下腔静脉的回缩 ,应用其治疗BCS效果良好。

Objective To discuss the feasibility of modified Z-stent in treatment of Budd-Chiari syndrome (BCS) and evaluate its clinical effect. Methods The type of BCS was determined with color Doppler ultrasonography for selection of the stent. The lesion in the inferior vena cava (IVC) was treated with PTA and the modified Z-stent. The bare part of the modified Z-stent was placed to the entrance of hepatic vein (HV). Finally, photography of the IVC and HV was performed to observe the stent site. Results A total of 18 patients were treated. The mean blood pressure in IVC dropped from 28.5±1.0 cmH 2O before to 8.6±0.9 cmH 2O after the procedure. The follow-up study in all the patients for 5-38 months showed that the blood flow was not abnormal in IVC and HV and the major symptoms and signs disappeared. Conclusions The use of modified Z-stent can avoid obstructing the entrance of HV and support the wall of IVC. Meanwhile, the stent can be safely used for treatment of BCS.