两种球囊导管治疗Budd-Chiari综合征的对比研究

A contrastive study of two kind of balloon catheters in treatment of Budd-Chiari syndrome

目的:探讨两种球囊导管治疗Budd-Chiari综合征的效果和适应证。方法:分别选用聚乙烯18 mm、20 mm球囊和Inoue 24 mm、26 mm球囊对52例肝段下腔静脉阻塞的病人进行了经皮腔内血管成形术(PTA),12例置放了血管内支架。术前、后行下腔静脉造影并行血液动力学检查。结果:PTA术后下腔静脉内径由1.9±0.4 mm增至19.5士6.5mm。下腔静脉压由3.24±0.88 kPa降至1.48±0.55 kPa。术后残余压力阶差聚乙烯18 mm球囊组、20 mm球囊组分别为0.77±0.32 kPa、0.62±0.53 kPa;Inoue 24 mm球囊组、26 mm球囊组分别为0.34±0.27 kPa、0.32±0.28 kPa。结论:PTA是治疗肝段下腔静脉阻塞型Budd-Chiari综合征的有效方法,应根据病变的类型选择不同的球囊,而大腔球囊、充分扩张是提高疗效、预防再狭窄的关键。

Objective: To evaluate the effects and indications of two kind of balloon cahteters (Polythene and Inoue) in percutaneous transluminal angioplasty (PTA) for treatment of Budd-Chiari syndrome,Methods: A total of 52 patients with pasthepatic inferior vena cave (IVC) obstruction syndrome were treated by PTA with Polythene. Inoue balloon catheters respectively. Stent was inserted in 12 cases. IVC pressure and right atrial pressure were measured, and pressure gradients were calculated before and after PTA. Results: The diameter of TVC was increased from 1. 9±0. 4 mm to 19. 5 ±6. 5 mm after PTA. The residual pressure gradient after PTA was 0. 77±0. 32 kPa in Polythene 18 mm group. 0. 62±0. 53 kPa in 20 mm Polythene group, 0. 34±0. 27 kPa in Inoue 24 mm group and 0. 32 ±0. 28 kPa in Inoue 26 mm group respectively. Conclusion: PTA (or companied by stent) is an effective treatment for poslhepatic inferior vena cava obstruction. Large balloon selection and effective dilation are key factors for the effect improvement and rcstenosis prevention.