膜性布-加综合征的治疗--介入或手术?

目的　探讨膜性BuddChiari综合症(BCS)的治疗方法,评价放射介入和根治性病变隔膜切除术对膜性BCS的治疗效果。方法　对1990年5月～1997年12月我院收治的342例膜性BCS病人的临床资料进行回顾性分析。结果　手术治疗182例(其中18例为介入治疗失败者),采用常温直视下病变隔膜切除;介入178例,采用经皮腔下腔静脉球囊扩张成形术(PTA)156例,经皮腔下腔静脉球囊扩张成形术及经皮肝肝静脉扩张成形术22例,其中10例加用血管内支架(Stent)放置。手术组随访177例中总有效率898%,复发率102%;介入组总有效率810%,死亡率17%(3例),复发率190%,介入失败112%。结论　大部分膜性BCS病人经PTA或PTA加血管内支架治疗可取得良好效果,对介入治疗失败者、下腔静脉内有血栓者、介入治疗后复发者或下腔静脉内为斜或厚膜的病人应选择根治性膜切除术。     

重症布-加综合征的治疗(附95例报告)

目的　 探讨重症布 -加综合征 (BCS)的治疗方法。 方法　 对 1994年 11月～ 1999年 6月收治的 95例重症BCS病人的临床资料进行回顾性分析。 结果　 手术治疗 75例 ,其中行肠腔静脉人工血管C型架桥吻合 5 1例 ,脾静脉与右颈内静脉人工血管架桥吻合 2 3例 ,肠系膜上静脉右颈内静脉人工血管架桥吻合 1例 ;介入治疗 10例 ,均行经皮肝肝静脉球囊导管扩张成形或 (和 )内支架放置 ;介入加常规手术 10例 ,经皮腔下腔静脉球囊导管扩张成形及内支架放置后行肠腔人工血管C型架桥术。除手术死亡 5例外 ,90例随访 6个月～ 5年 ,效果优者 6 5例 ( 72 .2 % ) ,良者 2 5例 ( 2 7.8% )。 结论　 对重症布加综合征病人应依据病变类型行相应的治疗方法 ,多数病人可取得良好效果     

布-加综合征的外科治疗

目的　分析多种手术及介入方法治疗布加综合征的疗效。方法　113例中行经皮腔内血管成形术(PTA)22例,PTA加支架置术术16例,脾肺固定加大网膜包肺术27例,经右房及股静脉联合破膜扩张并置支架术33例,下腔静脉右房人工血管转流术10例,直视根治加支架置入术5例。结果　术后病情缓解,下腔静脉压力由术前26～40cmH2O下降至术后15～25cmH2O,门静脉压力由术前37～51cmH2O下降至术后22～33cmH2O。结论　对下腔静脉或肝静脉膜性阻塞或狭窄且无新鲜血栓者,PTA加支架置入为首选措施,不宜用此法的患者以选择适当的手术加介入治疗为佳。     

球囊扩张血管成形治疗布－加综合征

采用球囊扩张下腔静脉成形术治疗布－加综合征４０例。４０例中男１８例，女２２例。病程１～２４年。病理类型为膜性下腔静脉阻塞（３７例）和短节段性下腔静脉阻塞（３例）。本组病例总扩张成功率为９２．５％（３７／４０）。１例因肺梗塞而死亡；５例下腔静脉侧壁被穿刺导丝刺穿，后者均经非手术治疗痊愈。随访３至３８个月，２例症状复发并再次接受手术治疗。作者指出，球囊导管扩张下腔静脉成形适应于布－加综合征的某些病理类型，如膜性下腔静脉阻塞和短节段性下腔静脉阻塞，可取得满意的效果。若Ｂ超或／和下腔静脉造影显示下腔静脉内有血栓者，则为球囊扩张成形术的绝对禁忌证。     

经皮球囊导管成形支架植入术治疗布-加综合征的临床观察

目的 探讨经皮下腔静脉球囊成形加支架植入术治疗布加综合征(BCS)的临床疗效。方法 120例患者均经彩色多普勒超声、下腔静脉及肝静脉造影等检查明确诊断，并进行经皮下腔静脉球囊成形(PTA)加支架植入术(EMS)治疗。所有病例随访6-108个月。结果 扩张前静脉狭窄段内径0-6mm(平均3mm)，肝静脉内径2mm。扩张并置放血管内支架后，腔静脉、肝静脉内径分别为18—20mm和8mm。扩张前下腔静脉至右房压力差为18-35cmH20(1．76-3．43Da)，平均20．3cmH20(1．989kPa)，扩张后压差消失，119例手术顺利，1例左肝静脉轻度损伤。术后96例主要症状及体征消失或基本消失，19例明显改善。120例(100％)获1-108(平均67．35)个月随访，其中门5例在随访期间血管内支架形态良好，支架内血流通畅；3例在术后8，11，16个月发生腔静脉再阻塞，经二次PTA EMS治愈；2例于术后2—3个月发生3支肝静脉再阻塞，转为外科手术。结论 经皮下腔静脉球囊成形、支架植入术是非长段阻塞型布—加综合征良好的治疗方法。     

多支架治疗血栓性膜型阻塞性布-加综合征

目的探讨血栓性膜型阻塞性布-加氏综合征(BCS)的介入治疗方法.方法对17例血栓性膜型阻塞性BCS患者实施多支架压栓并球囊扩张成形支架置入术.结果下腔静脉压力由术前的平均(9.40±3.13)cmH2 O 下降至术后的平均(13.45±3.32)cm H2 O.无肺栓塞等严重并发症发生.随访3～40个月,效果良好.结论对血栓性膜型阻塞性BCS,可施行多支架压栓的介入治疗.     

下腔静脉成形治疗复发性布-加综合征

目的　探讨复发性布 -加综合征的治疗方法。方法　常温非体外循环下阻断梗阻上、下端的下腔静脉 ,切开梗阻部位 ,取出血栓 ,矫正畸形 ,用自体心包补片成形下腔静脉。结果　 3 9例术后均肝脾肿大缩小 ,腹水消失或减少 ,下腔静脉压力降低 6～ 11cmH2 O。B超检查显示 :全部病人术后原下腔静脉狭窄处直径 3 .5cm ,血流通畅。术后 7例出现短暂血尿 ,5例出现心功能不全 ,其中 2例出现胸水 ,无 1例住院死亡。随访 3个月～ 6年 ,3例术后 1年内死于多器官功能衰竭 ,1例死于肺部疾病 ,2例术后 2年死于其他非相关疾病。 4例失访。 2 9例恢复正常生活 ,无复发肝脾大、腹水。结论　常温非体外循环下腔静脉成形治疗复发性布 -加综合征是一种有效的手术方法     

介入治疗布加综合征312例经验

目的　总结球囊扩张及支架治疗布加综合征 (Budd Chiarisyndrome ,BCS)的经验。方法　对 312例BCS患者行下腔静脉 (inferiorvenacava ,IVC)造影 ,确定病变部位、类型 ,再用导丝硬头或穿刺针穿通阻塞部位、球囊扩张、内置支架。结果　本组 312例 ,扩张成功 2 71例 ,其中IVC 2 6 0例 ,肝静脉 (hepaticvein ,HV) 11例 ,放置IVC支架 195例 ,HV支架 1例 ,无一例发生肺栓塞。术后发生急性肾衰 6例 ,肝昏迷 1例 ,急性心衰 2 1例 ,死亡 1例。并发IVC急性血栓形成 2例 ,死亡 1例。 2 0 3例获随访 6～ 10 4个月 ,复发 2 1例。结论　介入治疗BCS适应于多种病理类型 ,安全、有效。     

Superior vena cava rupture during balloon angioplasty and stent placement to relieve superior vena cava syndrome: a case report

Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. Three previous reports have described ruptures of the SVC during venoplasty with death on one occasion. We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.     

单球囊导管扩张及内支架置放治疗布-加综合征

目的评价单球囊导管扩张及内支架置放治疗膜性及段性布-加综合征.方法 3 4例布-加综合征接受了上、下腔静脉同时插管造影及下腔静脉单球囊导管扩张和内支架置放治疗.结果 33例穿刺、扩张成功.下腔静脉阻塞段分别被扩张至10～20 mm,9例置入金属内支架,阻塞下方下腔静脉压力从平均(2.71±0.78) kPa下降至(1.98±0.85) kPa.结论上下腔同时插管造影,阻塞段部位及长度显示清楚,单个大球囊置入简便,扩张确切,段性者配合内支架置入可在一定程度上预防再狭窄.     

21例下腔静脉放置支架治疗布-加综合征失误临床分析

目的探讨介入治疗布-加综合征(BCS)适应证及其失误后的外科治疗措施。方法回顾性分析21例行下腔静脉放置支架失误的BCS患者临床资料。结果21例失误中适应证选择不当6例,支架堵塞主肝静脉1例,堵塞扩张的副肝静脉10例,支架移位3例,支架未展开1例。19例改行手术治疗,其中18例行分流术,1例行下腔静脉隔膜根治性切除术。手术治疗的19例均获成功。18例分流术后自由门静脉压力(FPP)明显下降(P<0.05),无围手术期死亡。随访15例,随访时间为6个月至6年。有效率86.7%(13/15),复发率6.7%(1/15)。1例患者于术后2年死于肝性脑病。结论介入治疗BCS时要严格掌握其适应证,对介入治疗失误和复发病例可选用不同的分流手术。     

Pull-through technique with pincer tactics for stent placement in severe superior vena cava syndrome

The pull-through technique is an interventional radiological procedure used when an occluded lesion cannot be traversed from one direction. To pass the lesion, a long guidewire is traversed from the opposite side and pulled through the ipsilateral sheath using a snare wire. The present report describes a case of severe superior vena cava syndrome treated by stent placement using a pull-through technique with pincer tactics. We successfully placed a stent in the occluded right internal jugular vein to the superior vena cava using a bilateral approach by snaring a guidewire in the right subclavian vein.     

Budd-Chiari syndrome and inferior vena cava thrombosis in a nephrotic child

We observed Budd-Chiari syndrome in a boy aged 2 years 6 months with nephrotic syndrome due to hepatic vein and inferior vena cava thrombosis, confirmed by Doppler imaging. Normal values of the routine hemostatic parameters proved that they are of little predictive value for the thrombotic state. Immediate heparin infusion was initiated. High doses of heparin up to 59 IU/kg per hour were required for efficient anticoagulation. A remission of the nephrotic syndrome was achieved with vincristine. Oral anticoagulation with a vitamin K antagonist was continued for 6 months. Doppler imaging then indicated full re-establishment of the blood flow through the affected vessels. The clinical and Doppler data in this case are compatible with acute Budd-Chiari syndrome due to incomplete outflow obstruction of the hepatic veins and inferior vena cava. The favorable outcome was due to the immediate heparin infusion and prompt remission of the nephrotic syndrome. Doppler imaging was an important tool for non-invasive diagnosis and follow-up. Received: 31 May 1999 / Revised: 30 August 1999 / Accepted: 3 September 1999     

Treatment of inferior vena cava obstruction producing Budd-Chiari syndrome

We treated a patient who had an inferior vena cava (IVC) obstruction associated with Budd-Chiari syndrome. All of the right, middle, and left hepatic veins were completely obstructed. The IVC was obstructed by a membranous substance and thrombus at the hepatic portion and was completely occluded by a fibrous septum at the site of a suprahepatic coarctation. A cavotomy was performed transversely at the suprahepatic level and then longitudinally to the level just above the renal veins, and the obstructing tissue was removed. An additional vertical incision was made in the IVC over the coarctation, and an autologous pericardial patch was sutured in place to widen the IVC. The patient was discharged with the patency of the IVC restored.     

Surgical treatment of Budd-Chiari syndrome associated with superior vena cava obstruction; report of a case

We report a case of a 37-year-old woman with Budd-Chiari syndrome who underwent a radical treatment. She had had ascites, general edema, and liver dysfunction for 5 years. Preoperative cineangiogram showed a membranous stenosis at the retrohepatic inferior vena cava and the catheter could not be advanced into superior vena cava. In the operation, obstructed superior vena cava was identified. Membranous tissue at retrohepatic inferior vena cava was removed, and patch cavoplasty was performed under circulatory arrest through Senning procedure. Postoperative cavogram revealed good patency of inferior vena cava and her symptoms were disappeared.     

Percutaneous translumbar inferior vena cava catheter placement for long-term hemodialysis treatment

Central venous access for long term dialysis has always been a major difficulty, especially in cases where the traditional sites are no longer available. We present a case of a pediatric patient where the usual sites were occluded and he needed a reliable venous access for his dialysis. The inferior vena cava has been used in adult patients, but no reports were found in the pediatric literature. We chose this site as an alternative for this patient. The catheter was placed via a percutaneous translumbar approach, and remained in place for almost 2 years until the patient received a renal transplant.