布加综合征合并肝静脉血栓介入治疗的疗效观察

目的 评价布加综合征合并肝静脉血栓介入治疗的临床效果.方法 25例布加综合征合并肝静脉血栓形成的患者,均施行经导管尿激酶溶栓术、球囊扩张术和(或)支架置入术,术后随访采用肝脏超声检查,观察肝静脉、下腔静脉通畅情况及血栓有无复发.介入治疗前后肝静脉-右心房、下腔静脉-右心房压差的比较采用配对t检验.结果 治疗成功23例,其中血栓完全溶解18例,部分溶解5例,肝静脉及下腔静脉血流通畅,肝静脉-右心房压差由术前平均(29±7)cm H2O(1 cm H2O＝0.098 kPa)下降至术后平均(8±3)cm H2O(t=13.7,P＜0.01),下腔静脉-右心房压差由术前平均(19±4)cm H2O下降至术后平均(5±2)cm H2O(t=13.3,P＜0.01);不成功2例.23例患者随访1～42个月,平均(18±10)个月,死亡1例,肝静脉再狭窄2例,经再次球囊扩张治疗成功,其余20例无肝静脉再狭窄及血栓复发.结论 布加综合征合并肝静脉血栓的介入治疗可取得较好临床效果.

Abstract：

Objective To evaluate the effect of interventional therapy for Budd-Chiari syndrome with hepatic vein thrombosis. Methods Twenty-five patients with Budd-Chiari syndrome complicated with hepatic vein thrombosis underwent catheter-directed urokinase thrombolysis, balloon dilation and/or stent placement. During follow-up, re-thrombosis and patency of the recanalized hepatic vein and inferior vena cava were evaluated by liver ultrasound. The pressure gradient of hepatic vein-right atrium or inferior vena cava-right atrium before and after interventional treatment was compared with paired t-test. ResultsTechnical success was obtained in 23 patients. Complete resolution and partial resolution of the thrombi were accomplished in 18 cases and 5 cases, respectively. The recanalized hepatic veins and inferior vena cava were patent. The mean pressure gradient of hepatic vein-right atrium dropped from (29±7) cm H2O to (8±3) cm H2O (1 cm H2O＝0.098 kPa) after the interventional treatment (t=13.7,P<0.01). The mean pressure gradient of inferior vena cava-right atrium dropped from (19±4) cm H2O to (5±2) cm H2O after the interventional treatment (t=13.3, P<0.01). Failures occurred in 2 patients. Over the follow-up period of 1 to 42 months[(18±10) months]after interventional treatment in the 23 patients, one late death occurred. Restenoses of hepatic veins were found in 2 patients, which were all redilated successfully. Neither restenosis of hepatic vein nor recurrence of thrombosis was found in the other 20 patients. Conclusion Interventional therapy could be effectively performed for the treatment of Budd-Chiari syndrome with hepatic vein thrombosis.

Clinical evaluation of interventional treatment for Budd-Chiari syndrome with hepatic vein thrombosis

Objective To evaluate the effect of interventional therapy for Budd-Chiari syndrome with hepatic vein thrombosis. Methods Twenty-five patients with Budd-Chiari syndrome complicated with hepatic vein thrombosis underwent catheter-directed urokinase thrombolysis, balloon dilation and/or stent placement. During follow-up, re-thrombosis and patency of the recanalized hepatic vein and inferior vena cava were evaluated by liver ultrasound. The pressure gradient of hepatic vein-right atrium or inferior vena cava-right atrium before and after interventional treatment was compared with paired t-test. ResultsTechnical success was obtained in 23 patients. Complete resolution and partial resolution of the thrombi were accomplished in 18 cases and 5 cases, respectively. The recanalized hepatic veins and inferior vena cava were patent. The mean pressure gradient of hepatic vein-right atrium dropped from (29±7) cm H2O to (8±3) cm H2O (1 cm H2O＝0.098 kPa) after the interventional treatment (t=13.7,P<0.01). The mean pressure gradient of inferior vena cava-right atrium dropped from (19±4) cm H2O to (5±2) cm H2O after the interventional treatment (t=13.3, P<0.01). Failures occurred in 2 patients. Over the follow-up period of 1 to 42 months[(18±10) months]after interventional treatment in the 23 patients, one late death occurred. Restenoses of hepatic veins were found in 2 patients, which were all redilated successfully. Neither restenosis of hepatic vein nor recurrence of thrombosis was found in the other 20 patients. Conclusion Interventional therapy could be effectively performed for the treatment of Budd-Chiari syndrome with hepatic vein thrombosis.