节段闭塞性布加综合征的腔内治疗

目的 探讨节段闭塞性布加综合征的腔内治疗经验.方法 回顾性分析45例节段闭塞性布加综合征的临床资料.分别采用下腔静脉开通术、经皮经腔血管成形术(percutaneoustransluminal angiophsty,PTA)及支架植入术治疗.复杂的病例采用三维数字减影血管造影(three-dimensional digital subtraction angiography,3D-DSA)技术进行多角度评估下腔静脉病变,寻找腔内治疗最佳工作角度.结果 本组45例中,43例成功穿通并扩张.下腔静脉压由术前的(35.3±3.9)cm H2O降至术后的(9.5±2.0)cm H2O,两者差异有统计学意义(t=43.68,P<0.01).2例下腔静脉穿通失败,改行腔房人工血管转流术.1例行PTA时发生急性心包填塞.35例获得随访,随访率77.8%(35/45),随访时间3～46个月,平均28.6个月.除1例术后15个月支架内血栓形成而改行腔房人工血管转流术外,其他34例患者无支架移位及肝静脉阻塞.心包填塞病例经手术修补下腔静脉后治愈,随访6个月除肋间神经痛外无其他不适.本组无肺栓塞及死亡病例.结论 节段闭塞性布加综合征腔内治疗的近期、中期疗效较好.3D-DSA技术有助于布加综合征的腔内治疗.

Endovascular treatment of segmental occlusive Budd-Chiari syndrome

Objective To evaluate endovascular treatment of segmental occlusive Budd-Chiari syndrome(BCS). Methods We retrospectively analyzed the clinical data of segmental occlusive BCS of 45 cases. Inferior vena cava (IVC) puncture, percutaneons transluminal angioplasty (PTA) and stent implant were performed, respectively. Three-dimensional digital subtraction angiography (3D-DSA) was used to evaluate the IVC lesion from multi-angles and to identify the best work angle in complex BCS cases during endovascular treatment. Results IVC puncture and dilation was successful in 43 cases. The pressure of IVC decreased from (35. 3 ± 3.9)cm H2O to (9.5 ± 2. 0) cm H2O (t = 43. 68, P < 0. 01). The puncture failed in 2 cases and the patients were converted to veno-atrial graft shunt. Acute pericardial tamponade developed during PTA in one case. Postoperatively 35 cases were followed-up for 3 months to 46 months and the follow-up rate was 77. 8%. IVC stent thrombosis was identified in one case necessitating veno-atrial graft shunt 15 months post-operatively. There were no stent migration and hepatic venous obstruction in the remaining cases. The case of pericardial tamponade was cured and discharged after IVC repair. Symptoms disappeared except for intercostal neuralgia during 6 months follow-up. There were no pulmonary embolism and death. Conclusions Good medium and long term result could be achieved after endovascular treatment of segmental occlusive BCS. 3D-DSA is helpful for endovascular treatment of BCS.