下腔静脉节段闭塞型Budd-Chiari综合征应用颈一股静脉会师法行下腔静脉开通术30例报告

目的 研究Budd-Chiari 综合征介入治疗的新技术,应用颈一股静脉会师法行下腔静脉开通术.方法 30例下腔静脉节段闭塞型Budd-chiari综合征患者采用经静脉途径行近心端造影并留置导管作为穿通闭塞下腔静脉的靶标记,然后经股静脉途径应用房问隔穿刺针行下腔静脉开通术,球囊扩张和内支架植入.结果 30例患者采用此项技术全部取得成功临床症状消失,未出现并发症.结论 颈一股静脉会师法行下腔静脉开通术在下腔静脉节段闭塞型Budd-Chiari综合征介入治疗中是一种安全和实用的方法.     

下腔静脉节段闭塞型Budd-Chiari综合征应用颈—股静脉会师法行下腔静脉开通术30例报告

目的研究Budd-Chiari综合征介入治疗的新技术,应用颈-股静脉会师法行下腔静脉开通术。方法30例下腔静脉节段闭塞型Budd-Chiari综合征患者采用经静脉途径行近心端造影并留置导管作为穿通闭塞下腔静脉的靶标记,然后经股静脉途径应用房间隔穿刺针行下腔静脉开通术,球囊扩张和内支架植入。结果30例患者采用此项技术全部取得成功临床症状消失,未出现并发症。结论颈-股静脉会师法行下腔静脉开通术在下腔静脉节段闭塞型Budd-Chiari综合征介入治疗中是一种安全和实用的方法。     

下腔静脉滤器置入术预防DVT继发肺栓塞的临床观察

目的 探讨下腔静脉滤器置入术在治疗下肢深静脉血栓中预防肺栓塞的作用.方法 2003年1月至2006年12月,我院行下腔静脉滤器置入共36例,其中男性24例;女性12例.年龄35-78岁,平均年龄58.3岁.深静脉血栓位于右下肢8例,左下肢22例,双下肢6例.常规行下腔静脉造影,确定下腔静脉以及释放路径有无血栓形成,将滤器放置在肾静脉开口下的下腔静脉.结果 本组病例均释放成功,经股静脉途径15例,经右侧颈内静脉途径21例,术后随访1-24月,全部病例均未出现肺栓塞.结论 下腔静脉滤器置入可以预防下肢深静脉继发肺动脉栓塞的发生.     

下腔静脉滤器植入术预防肺动脉栓塞临床分析

目的 探讨下腔静脉滤器植入术在治疗下肢深静脉血栓中预防肺动脉栓塞的作用。方法 2001年3月-2005年1月,经股静脉穿刺放置永久性下腔静脉滤器12例,其中男性8例,女性4例。年龄44-81岁,平均54．2岁。深静脉血栓位于右下肢4例,左下肢8例。常规行下腔静脉造影,了解并确定下腔静脉和释放途径无血栓形成,将滤器放置到肾静脉开口下的腔静脉。结果 本组病例均释放成功,12例均经股静脉释放．术后随访1-24个月,无肺栓塞发生。结论 经皮穿刺下腔静脉滤器植入术操作简便,可以有效地预防下肢深静脉血栓患者中导致致命的肺动脉栓塞的发生。     

应用导管溶栓及置入下腔静脉滤器预防肺栓塞

目的 评价导管溶栓治疗下肢深静脉血栓形成的效果及置入下腔静脉滤器预防下肢深静脉血栓脱落引起肺栓塞的价值.方法 对39例下肢深静脉血栓患者分别经股静脉(30例)、右颈静脉(9例)置入下腔静脉滤器,滤器位于双肾静脉水平以下的下腔静脉内,下腔静脉滤器植入后将溶栓导管插入血栓之髂股静脉进行溶栓.药物尿激酶80～100万u,肝素1mg/kg.结果 下腔静脉滤器置入全部成功,术中导管溶栓32例完全再通及部分再通,余16例术后溶栓成功.结论? 经导管术中溶栓成功率高,效果好,置入下腔静脉滤器防止肺栓塞是安全有效的方法.     

布-加氏综合征的介入治疗(附10例报告)

目的探讨布-加氏综合征(BCS)介入治疗的方法及评价其疗效。方法对10例不同类型的BCS患者行介入治疗。方法:①经颈静脉下腔静脉途径行肝静脉开通;②经皮经肝穿刺肝静脉途径行肝静脉开通;③经颈静脉和股静脉双向会师行下腔静脉开通。术中常规行肝静脉和下腔静脉造影并测压。结果10例均获成功。6例患者球囊扩张后植入网状金属内支架,其中肝静脉支架2枚,腔静脉支架4枚。结论介入治疗BCS安全有效,可作为治疗该病的首选方法。     

Budd-chiari综合征下腔静脉长段闭塞普通导丝钝性开通5例报告

目的：探讨Budd-chiari综合征下腔静脉长段闭塞普通导丝钝性开通技术临床应用的安全性。方法：下腔静脉节段性闭塞5例患者,其中1例合并肝静脉狭窄或闭塞。透视下,使用普通导丝开通闭塞段下腔静脉。结果：5例技术操作全部成功,下腔静脉开通率100%,未出现心脏填塞、下腔静脉破裂、胸腔出血、腹腔出血等严重并发症。结论：Budd-chiari综合征下腔静脉长段闭塞普通导丝钝性开通操作简单、安全有效、费用低、无严重并发症,值得大力推广。     

下肢深静脉血栓所致的急性肺动脉栓塞双介入治疗

目的 评价双介入技术在治疗下肢深静脉血栓所致的急性肺动脉栓塞的临床疗效.方法 经右颈内静脉或健侧股静脉放置下腔静脉滤器38枚,常规行下腔静脉造影,确定下腔静脉和释放途径无血栓形成,将滤器放置于肾静脉开口以下的下腔静脉,后经皮经肺动脉置管溶栓治疗,术后常规抗凝.结果 38例患者下腔静脉滤器放置成功,临床症状明显改善,对全...     

下腔静脉滤器置入术预防肺动脉栓塞96例临床分析

目的：探讨经皮穿刺下腔静脉滤器置入术在治疗下肢深静脉血栓中预防肺动脉栓塞的作用。方法：2003年3月-2006年6月。经股静脉或颈静脉穿刺放置永久性下腔静脉滤器96例。男54例。女42例；年龄34-90岁，平均66．7岁。深静脉血栓位于右下肢42例，左下肢51例，双下肢3例。常规行下腔静脉造影．了解并确定下腔静脉和释放途径无血栓形成，将滤器置于肾静脉开口下的腔静脉。结果：本组96例均释放成功，其中3例双下肢深静脉血栓的患者经颈静脉释放，其余均经股静脉释放；2例在超声定位下释放，其余均存静脉造影下完成。术后随访1-39个月。均无肺栓塞发生。结论：经皮穿刺下腔静脉滤器置入术操作简便．可以有效预防下肢深静脉血栓致肺动脉栓塞的发生。     

腹膜后肿瘤切除术中单纯结扎和切除下腔静脉的可行性

目的 腹膜后肿瘤累及下腔静脉时,评估单纯结扎和切除下腔静脉的可行性和安全性.方法 2007年12月至2008年12月收治的腹膜后肿瘤病人116例,接受手术的93例完全切除率93.55%,肿瘤累及下腔静脉共13例(11.2%),按照肿瘤累及位置将下腔静脉分为3个节段,A:第二肝门至肾静脉以上;B:肾静脉节段下腔静脉;C:肾静脉以下至髂血管分叉.结果 A组2例,B组2例,C组8例,1例累及下腔静脉全程.下腔静脉修补5例,肾静脉以下至髂血管分叉下腔静脉单纯切除、远近端缝扎4例,肾静脉平面节段下腔静脉切除,两侧肾静脉结扎1例,第二肝门至肾静脉以上平面结扎2例,下腔静脉全程切除1例.结论 腹膜后肿瘤累及并导致F腔静脉闭塞时,第二肝门至肾静脉以上平面下腔静脉结扎并不影响肾脏和其他盆腔器官的血液同流,切除累及肾静脉平面下腔静脉时,肾功能可能受损.肾静脉以下至髂总静脉分叉平面受累的下腔静脉无论是否闭塞,均可安全结扎或切除.     

Y型人工血管转流治疗混合型布加综合征患者的疗效分析

目的 探讨肠-腔-房Y型人工血管转流治疗混合性布加氏综合征患者的疗效.方法 对1990-2006年于河南省人民医院收治的51例混合性布加氏综合征患者实施了肠-腔-房Y型人工血管转流.先于肝前行人工血管(直径16～18 mm,主血管)与肾静脉以下下腔静脉和右心房的吻合,然后再行人工血管(直径10～12 mill,支血管)与肠系膜上静脉和主血管的吻合.监测手术前、后下腔静脉、门静脉压力及血流流速.结果 手术后即日胸腹壁浅静脉曲张消失,无住院期死亡病例.随访6个月至16年,随访期内主血管未发现血栓,通畅率100%,支血管血栓形成2例,通畅率为96.1%.术后下腔静脉压力较术前下降了17.4 cm H2O±5.7 cm H2O(1 cm H2O=0.098 kPa),门静脉压力下降了17.0 cm H20±7.0 cm H20.结论 Y型人工血管转流能同时有效地降低下腔静脉及门静脉压力并不增加术后并发症,是治疗混合性布加氏综合征较为理想的手术方式.     

置入下腔静脉滤器预防肺栓塞

目的探讨下肢深静脉血栓形成患者置入下腔静脉滤器预防肺动脉血栓的临床疗效。方法34例经彩超证实为下肢深静脉血栓患者,于下腔静脉内置入滤器,然后经患肢的足背静脉推注尿激酶进行溶栓治疗,观察疗效,并随访肺栓塞的发生情况。结果34例患者下腔静脉滤器均展开良好,无移位。其中,痊愈6例,显效24例,有效4例,无效0例。随访1-12月未发现肺动脉栓塞发生。结论下肢深静脉血栓形成患者置入下腔静脉滤器可有效预防肺栓塞的发生。     

腔静脉滤器预防肺栓塞的临床应用

目的:评价置入腔静脉滤器预防因静脉血栓脱落引起肺栓塞的效果和安全性.方法:19例下肢深静脉血栓和1例上肢深静脉血栓患者均置入钛质Bird'snestfilter(BNF).滤器位于双肾静脉水平以下的下腔静脉内或上腔静脉干内.术后分别于1、6、12个月摄胸或腹部平片复查,观察滤器的位置、形态变化.结果:全部滤器经股静脉或右颈内静脉穿刺置入,经右股静脉15例,左股静脉3例,右颈内静脉2例.无严重并发症发生.随访发现2例向头侧移,1例向足侧移位,2例跨度增大,腹部CT发现滤器的2只脚穿透腔静脉壁,未出现任何症状,无1例滤器发生倾斜.无1例发生腔静脉阻塞或复发肺栓塞.结论:置入腔静脉滤器预防肺栓塞是安全、有效的方法.     

CT静脉成像在布加综合征诊疗中的应用

目的：探讨CT静脉成像（CTV）技术在布加综合征（BCS）诊疗过程中的应用价值。方法对2012年1月至2014年1月该院收治的58例BCS患者进行CTV检查,对下腔静脉、肝静脉、门静脉及侧支血管进行重建分析。结果所有患者均完成CTV检查,被明确诊断为BCS。其中下腔静脉隔膜型19例,短段病变型15例,长段病变型8例,肝静脉型9例,合并血栓形成的7例。所有患者均见到侧支血管不同程度的代偿扩张,肝脏硬化及脾脏肿大等表现。结论 CTV技术的应用对于BCS的诊疗具有图像清晰、直观、全面,能够显示病变血管部位、性质及长度的优点,还能观察侧支血管扩张及肝硬化程度。     

Radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment

Background Several kinds of radical surgery for the treatment of Budd-Chiari syndrome （BCS） have been devised. We have described preliminary efforts to treat BCS using a novel radical resection technique to expose the entire inferior vena cava （IVC） of the hepatic segment. Methods Sixty patients with BCS were treated by radical resection, including 46 men and 14 women. BCS patients ranged in age from 11 to 62 years, with 3 months to 11 years since the BCS diagnosis. The lesions included membrane occlusion of the IVC in 16 patients, double membranes within the IVC in 2 patients, double membranes within the IVC and the hepatic vein （HV） in 3 patients, IVC membrane with distal thrombosis in 10 patients, long segment thrombosis of the IVC in 5 patients （organized thrombosis in 2 patients, fresh thrombosis in 3 patients）, occlusion of the outlet of the HVs due to mural thrombosis in 2 patients, segmental occlusion of the IVC in 3 patients, membranes within the HV with IVC stenosis due to protrusion of HV stent in 1 patient, HV membranes in 11 patients, extensive occlusion of HVs in 1 patient, the whole IVC tumor thrombus with tumor thrombus of 2/3 right atrium resulting from a posterior peritoneum tumor in 1 patient, IVC leiomyosarcoma in 2 patients, IVC leiomyosarcoma with tumor thrombus into 1/2 right atrium in 1 patient, IVC thrombosis extending into right atrium in 1 patient, compression of supra-hepatic segment of IVC due to fiber trabs in 1 patient. Results All lesions were successfully resected under direct supervision. Three procedures were performed under extracorporeal circulation, 52 patients with catheterization of the right atrium, 4 patients with a cell saver, and one patient with auto-retrieval of blood. The retrieved blood was from 300 ml to 4000 ml. Transfusion of banked blood was from 400 ml to 2000 ml for 14 patients. For the other patients no transfusion of banked blood was required. One patient died of renal failure peri-operatively. Newly formed IVC membrane was found for one recurrent patient whose IVC thrombosis was removed one year prior. Restenosis of the IVC was observed post-operatively without symptoms in one patient. In the other patients, no recurrent symptom was found during the follow-up periods. Conclusion This novel surgery provides a clear visual field during the procedure and yields satisfactory short and Iona-term results.     

Preliminary evaluation of magnetic resonance fresh blood imaging for diagnosis of Budd-Chiari syndrome

Background Budd-Chiari syndrome （BCS） is a rare disease with portal hypertension caused by the blockage of the hepatic vein and/or the inferior vena cava （IVC）. Angiography is the ＂golden standard＂ for diagnosis, but it is an invasive examination. To assess the diagnostic value of a fresh blood imaging （FBI） relative to BCS, we used a magnetic resonance angiography （MRA） with an FBI sequence for a preoperative evaluation of the BCS patients in this study. Methods Fifty patients who were suspected of having BCS after they had been checked by a B-ultrasound were studied. 2D and 3D FBI were performed on a 1.5T superconductive MR scanner. Original images were rebuilt using a maximal intensity projection （MIP） method on the console. Two doctors reviewed all images before they learned of the angiography results. We then compared the diagnoses obtained from the FBI and angiography results to evaluate the diagnostic value of the FBI. Results Forty-one patients were diagnosed as BCS and 9 as non-BCS based on an angiography. The FBI correctly diagnosed 38 patients, incorrectly diagnosed 1 patient, and missed diagnosis in 3 patients. Thus, the diagnostic sensitivity of the FBI is 93% （38/41）, the specificity is 89% （8/9） and the accuracy is 92% （46/50）. The FBI images of the 13 membranous stenoses of the IVC showed a sudden stenosis of the post-liver segment of the IVC. The Images of the 5 patients with a membranous obstruction of the IVC showed IVC thickening and an absence of blood signals in the post-hepatic segment of the IVC. The images of the 4 patients with the segmental thrombosis of the IVC showed abnormal and intermittent signals in the IVC. The images of the 6 patients with a simple hepatic vein obstruction showed obstructive hepatic veins. The images of the 6 patients with the stenosis of both the IVC and the hepatic veins showed the stenosis of the IVC, the thickening of the hepatic veins and the formation of a compensatory circulation within the liver. Lastly, the images of the 7 patients showed a combination of the IVC thrombosis with stenosis or with the obstruction of one or two hepatic veins. Conclusions An FBI can show a membranous stenosis, and an obstruction and thrombosis of the IVC. In addition, it can also demonstrate the thickening of the flexural hepatic vein and the development of intra-hepatic compensatory branches with slow blood flow. Thus, it can guide the puncturing and opening of the hepatic vein involved in an interventional therapy for BCS patients.     

彩色多普勒超声对布加综合征下腔静脉病变的诊断价值

目的探讨彩色多普勒超声对布加综合征下腔静脉病变的诊断价值。方法应用彩色多普勒超声探查布加综合征147例,并与下腔静脉造影结果比较。结果彩超显示147例中下腔静脉通畅17例,膜性狭窄55例、膜性闭塞48例,节段性狭窄1例,节段性闭塞26例,其中合并血栓20例。与下腔静脉造影结果相比彩超定性诊断符合率98.64%,准确率94.56%。结论彩色多普勒超声诊断布加综合征下腔静脉病变准确率高,应作为首选诊断方法。     

Clinical study of domestic ZQL-type retrievable vena cava filter

Background Pulmonary thromboembolism （PTE） is a serious disease often leading to disability and death. Percutaneous placement of an inferior vena cava （IVC） filter is an effective method to prevent fatal PTE caused by lower extremity deep venous thrombosis （LEDVT）. We developed the ZQL-type retrievable vena cava filter. The aim of this study was to evaluate the safety and effectiveness of the ZQL-type filter for prevention of fatal PTE. Methods A total of 144 patients with indications for placement of an IVC filter received insertion of filters via a femoral （n=37） or jugular （n=107） vein approach. Abdominal X-ray and color Doppler ultrasonography of IVC were regularly performed to visualize the position and condition of the IVC filter following filter placement. If thrombi in the lower extremity deep veins were removed within 2 weeks, the filter retrieval procedure was performed after an abdominal radiograph, an inferior vena cavogram and a pulmonary angiography. Otherwise, the filter should be kept permanently in place with regular follow-up inspections. Results One hundred and forty-four filters were implanted at the target sites with a success rate of 98.61% for one-time placement and 100% for two-time placement. Of the 137 patients followed up （follow-up rate, 95.14%）, 43 patients had filters retrieved during a period of between 7 and 14 days （median, 12 days） following filter placement. The remaining 94 patients were followed for 7 days to 39 months （median follow-up period, 17 months）. No filter migration or tilt, filter fracture or IVC perforation was observed. No obstruction of IVC occurred. No symptomatic PTE developed during the follow-up period. Conclusion The ZQL-type retrievable vena cava filter is a safe and effective device to prevent PTE. This filter possesses a distinctive stent-shape, stable design, high capture efficacy, and is easy to insert and retrieve and thus is suitable for clinical application. Chin Med J 2009; 122（2）： 140-144     

经血管内溶栓和成形术治疗布-加氏综合征合并下腔静脉血栓形成

目的探讨经血管内溶栓加成形术治疗布-加氏综合征(Budd-Chiari syndrome,BCS)合并下腔静脉(IVC)血栓的应用价值。方法本组26例,采用经血管行IVC血栓内溶栓、大球囊成形术、球囊分次扩张加支架压迫血栓成形术;其中21例置管溶栓与我院早期18例全身静脉溶栓对照。结果造影发现26例IVC肝段上方呈膜性孔型狭窄或闭塞,膜下血栓形成。21例行IVC置管溶栓,溶栓效果明显高于全身静脉溶栓(P<0.01);7例血栓消失后行球囊成形术,14例血栓缩小后行球囊加支架成形术。5例急症患者行球囊加支架成形术。24例治疗成功,成功率92.3%。术前下腔静脉压力(28±6)cmH2O,术后压力(14±4)cmH2O,术前术后下腔静脉压力下降明显(P<0.05)。并发症2例,1例内支架闭塞,1例肺栓塞,占7.7%。随访3-72个月,平均36个月,20例临床症状和体征消失,5例明显缓解,1例3个月后再次上消化道出血死亡。结论介入治疗BCS合并IVC血栓具有微创性、可重复、安全有效,成为主要的治疗方法。     

复合手术治疗无残端的症状性长段颈内动脉慢性闭塞

目的:总结采用复合手术方法治疗无残端症状性长段颈内动脉慢性闭塞(chronic internal carotid artery occlusion,CICAO)病变的初步经验。方法:回顾性总结分析2015年7月至2017年12月北京大学第三医院介入血管外科采取复合手术的方法进行治疗的12例无残端的症状性长段CICAO患者资料,初步分析手术的安全性及有效性。结果:11例患者获得技术成功,技术成功率91.7%(11/12),仅1例发生主要并发症,该患者术中出现颈内动脉海绵窦瘘,结扎颈内动脉近端后好转。全部12例患者无缺血性及出血性卒中,无死亡病例。10例患者获得随访,随访10~32个月,平均随访时间(19±9)个月,其中1例出现症状性支架内再狭窄,予再次手术治疗后好转。结论:对于经严格筛选的无残端的症状性长段CICAO患者,复合开通手术在技术上可行,有较高的手术安全性及技术成功率。