脾-颈静脉转流加门奇断流治疗布-加综合征并上消化道出血

目的 探索布—加综合征合并上消化道出血的最佳手术方式。方法 对15例重症布—加综合征合并上消化道出血患者，采用脾切除、脾静脉—右颈内静脉血管间置转流加门奇断流术治疗，并进行随访。结果 15例全部治愈，无手术死亡，并发症2例，1例切口感染，1例肺部感染，随访3～24个月，无再出血者，间置血管通畅良好。结论 对重症布—加综合征合并上消化道出血者，行脾切除，脾—颈静脉血管间置转流加门奇断流止血效果确切，是一种安全、有效的手术方法。     

介入治疗技术在Budd-Chiari综合征治疗中的地位

Ｂｕｄｄ Ｃｈｉａｒｉ综合征 (ＢＣＳ)由于病理改变复杂 ,外科治疗方法多种多样 ,主要包括 :(1)间接门脉减压术 ,如脾肺固定术、大网膜肺固定术等。 (2 )分流术 ,如脾肾分流术、肠腔分流术、肠系膜上静脉右心房转流术、脾静脉颈内静脉胸骨后转流术、腔房转流术和腔腔转流术等。 (3)血管成形术 ,如隔膜破裂术、病变隔膜切除术等。 (4)肝移植术。近 30年来 ,介入治疗技术在Ｂｕｄｄ Ｃｈｉａｒｉ综合征 (ＢＣＳ)治疗中应用逐渐增多 ,技术趋于成熟。主要包括 :球囊扩张术 (ＰＴＡ) ,血管内支架 (ＥＭＳ)置入术和经颈静脉或经皮肝途径行肝内门…     

腔内治疗髂静脉受压综合征合并急性下肢深静脉血栓的近期疗效

目的评价腔内技术治疗髂静脉受压综合征合并急性下肢深静脉血栓的疗效。方法 2008年3月至2011年3月,24例髂静脉受压综合征合并急性下肢深静脉血栓患者在DSA下行下肢深静脉内导管溶栓治疗,19例同时行球囊扩张并支架置入治疗,5例3～6个月后球囊扩张并支架置入治疗。以健、患肢周径差及静脉血栓溶解率来评价疗效。结果经导管溶栓治疗后静脉通畅度评价：Ⅰ级（0～50%溶解）4例（16.7%）,Ⅱ级（50%～99%溶解）15例（62.5%）,Ⅲ级（完全溶解）5例（20.8%）。经球囊扩张并支架置入治疗后肢体肿胀评价：治愈10例（41.7%）,有效14例（58.3%）。7例患者发生支架内血栓形成。结论静脉腔内导管溶栓结合球囊扩张和支架置入是治疗继发急性下肢深静脉血栓的髂静脉受压综合征的有效手段。     

布加综合征不同治疗术式的彩超表现

目的了解布加综合征不同治疗术式后的彩超表现。方法布加综合征患19名，均经手术或血管造影证实，并行外科手术或放射介入治疗，所有病例术后均行彩超检查。结果14例介人手术包括6例行下腔静脉球囊扩张术，1例肝中静脉球囊扩张术，7例下腔静脉内支架植入术。彩色多普勒显示13例手术处血流通畅，方向正常，流速范围为0．20～1．76m／s，其中9例流速大于1．0m／s。5例外科手术中1例行经右心房下腔静脉破膜成形术，2例腔一房转流术，1例腔一颈转流术，1例肠一腔转流术。彩色多普勒显示3例人造血管血流通畅，流速为0．60～1．50m／s。结论彩超对布加综合征不同术式后的随访有重要价值。     

布加综合征18例介入治疗围手术期的护理

目的观察介入治疗对布加综合征的治疗效果,探讨其护理方法。方法收集南京军区南京总医院普外科13例布加综合征患者行经颈内静脉途径下腔静脉球囊扩张+血管支架置入术;5例行颈内静脉途径肝静脉球囊扩张术。围手术期采取专科护理,严密观察患者的症状及不良反应。结果通过有效的围手术护理,无一例并发症发生。结论有效的围手术期护理保证了介入治疗的效果。     

布加综合征介入治疗的临床研究

目的 探讨布加综合征血管内介入治疗的价值.方法 12例布加综合征患者,病理类型:下腔静脉完全阻塞9例,下腔静脉狭窄3例;治疗均行下腔静脉球囊扩张成形术+支架置入术.结果 12例均成功施行此术式,治疗前下腔静脉压力平均(4.56±1.51)kPa(1 mm Hg=0.133 kPa),支架置入后下腔静脉压力下降至平均(2.51±0.77)kPa,临床症状明显缓解.但1例在下腔静脉支架置入术后8个月并发肝静脉闭塞,行肠房分流术后症状缓解.结论 选择合适病例,血管内介入治疗布加综合征是安全可行的.     

布加综合征650例诊治体会

目的 探讨布加综合征诊断及治疗方法。方法 本组共650例布加综合征病人，分别采取介入加支架、单纯介入、介入加肠腔分流、肠腔分流术、联合术、根治术、腔房转流术、腔肠房转流术、腔肠颈转流术、肠房转流术10种手术方法治疗。结果 随访最长时间9年2个月，术后总生存率96％(627／650)，人工血管5年通畅率90％(28／31)。结论 布加综合征病理类型复杂，治疗棘手，需根据不同的病理类型和血管外科技术，采取相应的治疗方法，方能取得良好的效果。     

肠-腔人工血管分流治疗布-加综合征10例分析

目的：讨论肠-腔分流术在布加综合征治疗中的应用价值。方法：对我院10例布-加综合征惠者手术前、后临床效果的对比分析。结果：肠腔分流术可有效降低门脉压力，术前、术后门脉压力有显著性差异，无围手术期死亡，随访3个月～4年，无再出血．肝脾明显缩小，腹水消失。结论：肠-腔人工血管分流术治疗布加综合征，可有效降低门脉压力，预防上消化道出血。     

左髂静脉压迫综合征的腔内治疗

目的 探讨左髂静脉压迫综合征腔内治疗的效果.方法 我院191例左髂静脉压迫综合征患者均采用腔内治疗,经左股静脉入路,seldinger技术穿刺置入导管鞘并交换Amplatz导丝引入球囊扩张狭窄段,反复扩张后置入自膨式网状支架,对合并下肢静脉曲张的患者二期手术治疗,对合并血栓者先行下腔静脉滤器置入和左下肢深静脉插管溶栓,后在数字减影血管造影下行髂静脉经皮血管内成型(PTA)+内置支架术(stenting).结果 本组无手术死亡,169例治愈,12例好转,10例未愈,单纯行PTA者31例,置入支架150例.置入支架后造影见痛变髂静脉恢复通畅,支架放置到位及扩张良好,无移位至下腔静脉.合并血栓形成者均无肺动脉栓塞发生,血栓完全溶解15例,部分溶解8例,血栓后综合征表现8例,出院时肢体肿胀明显缓解,静脉曲张者曲张静脉症状减轻,合并溃疡者溃疡面积均有不同程度的减小.120例随访者中只有5例支架内血栓形成,单纯PTA和PTA+stenting 1、2年累计通畅率分别为85%(102/120)、65%(78/120)和89%(107/120)、78%(94/120).结论 血管腔内介入治疗左髂静脉压迫综合征创伤小,操作简单而且安全、有效.     

经颈经肝联合介入治疗肝静脉型布加综合征16例

目的:观察经颈经肝联合介入治疗肝静脉型布加综合征的疗效。方法:采用经颈经肝联合入路介入治疗肝静脉型布加综合征患者16例,扩张病变肝静脉主干直径至10～12mm,其中2例于右肝静脉主干置入支架。结果:全组病例无手术死亡,全部痊愈出院,出院时腹水消退,脾脏明显缩小。随访3～38个月,1例复发,右肝静脉狭窄至2mm,再次球囊扩张后痊愈,复发率6%。结论:重视肝静脉型布加综合征的诊断,采用经颈经肝联合介入治疗肝静脉型布加综合征具有创伤小、恢复快及疗效确切等优点,治疗效果满意,远期疗效有待进一步观察。     

Clinical spectrum, investigations and treatment of Budd-Chiari syndrome

The clinical presentation, investigations, therapeutic modalities, prognosis and outcome of 44 patients with Budd-Chiari syndrome (BCS) were reviewed. There were 27 women and 17 men. Median age at presentation was 37 years (range 14-60). Possible aetiological factors were identified in 31 patients (70%). Myeloproliferative disorders were the commonest aetiology. Abdominal pain and swelling were the commonest presenting symptoms. Sixteen patients underwent a shunt operation (14 mesocaval, 2 mesoatrial). Ten patients had liver transplantation. Eleven patients had angioplasty/stent as their only treatment, and seven were treated medically or died before any treatment was instituted. Radiological intervention was comparable to mesocaval shunt in relieving patients' symptoms and in achieving good long-term results. Medical treatment and liver transplantation both yielded poor results. Radiological intervention in the form of balloon angioplasty or stent placement gives good results in a subgroup of BCS patients, and should be tried first to relieve the hepatic outflow obstruction. Mesocaval shunts provide good results in selected cases. Underlying haematological causes should be intensively investigated and promptly treated.      

血管内介入治疗Budd-Chiair综合征疗效分析

目的探讨血管内介入治疗Budd-Chiair综合征的临床价值。方法回顾分析47例Budd-Chiair综合征病例的介入治疗及临床资料,12例行球囊扩张成形术,33例行球囊扩张成形术加支架置入术,2例穿刺未成功行手术治疗。结果介入治疗成功率95．7％（45／47）,患者症状缓解,未出现肺拴塞、出血等严重并发症。45例术后平均随访38个月,5例支架内继发血栓形成,其中1例支架内再次置人支架,4例经溶栓后症状缓解。结论血管内介入治疗布加氏综合征安全有效,应予推广。     

Peri-stent vascular channels after transjugular intrahepatic portosystemic shunt placement for Budd–Chiari syndrome: CT and US findings

Transjugular intrahepatic portosystemic shunt (TIPS) placement has been used as a bridge to transplantation in patients with Budd-Chiari syndrome. Stent occlusion is a fairly common but seldom described complication after TIPS placement for Budd-Chiari syndrome. I present a case of a patient with Budd-Chiari who developed vascular channels paralleling an occluded stent. These channels were demonstrated only by power Doppler ultrasound and resulted in an unusual transient hepatic attenuation difference around the stent on computed tomography.     

The application and efficacy of stent place for Budd-Chiari syndrome

Objective To evaluate the application value and efficacy on stent place for Budd-Chiari syndrome (BCS).Methods From January 1990 to May 2017, 2228 patients with BCS were admitted to our institution. The mean age was 43.3 years. Stents were placed in inferior vena cava (IVC), hepatic vein (HV), or both after balloon dilation. During follow-up period, the patency of stent was evaluated by ultrasound regularly and the clinic sign was surveyed by letter, telephone or clinic visit. The restenosis of stent were treated with balloon dilatation and thrombolysis to restore the its function.Results IVC type was diagnosed in 1492 cases, HV type in 510 cases, and mixed type in 226 cases. Eighteen patients aborted treatment because of economic reasons, advanced liver cancer, severe scoliosis, or both bilateral iliac veins and total IVC occlusion. Among the other 2210 cases who underwent endovascular therapy, stents were implanted into IVC in 339 cases, HV in 97 cases, mixed type in 64 cases. The rate of restenosis in IVC stent was 11.50% (39/339). After repeat angioplasty, the long-term patency rate reached to 98.12%. The incidence of HV occlusion caused by IVC stent was 12.09% (n = 41). Restenosis occurred in 47 cases (48.45%) after HV stent placement. However, the 5-year patency rate was 91.75% (89/97) after repeat dilatation and stent re-implantation. The incidence of IVC obstruction caused by HV was 3.33% (3 cases).Conclusion IVC stent placement appears to be an effective treatment for the cases of IVC segmental occlusion, and at the same time, the stent has the dual role of compression and fixation of thrombus and support of lumen. The HV and accessory hepatic vein obstruction could happen when the IVC stent crossed these veins ostium. The incidence of the stent restenosis in the HV was higher than that in the IVC.     

经皮肝穿刺肝静脉成形术治疗肝静脉阻塞型Budd-Chiari综合征的临床研究

目的：探讨经皮肝穿刺入路肝静脉腔内成形治疗肝静脉型Budd—Chiari综合征（BCS）的可行性和中远期疗效。方法：1996年9月-2006年10月收治单纯肝静脉阻塞型及肝静脉阻塞伴有下腔静脉阻塞型B-CS患者101例，男52例，女49例；平均年龄31.3岁（15～57岁）。透视下首先行经皮肝穿刺入路肝静脉造影，明确阻塞部位、程度及侧枝循环形成情况，再行阻塞段开通及球囊扩张或支架成形术治疗。结果：肝右静脉球囊扩张66例，支架植入2例；肝左静脉球囊扩张11例；副肝静脉球囊扩张13例，技术成功率91％（92／101）。随访74例，术后6个月、1年和2年的受干预血管的初始再通率分别为83．78％（62／74）、78．38％（58／74）和76．47％（39／51），其辅助再通率分别为94．59%（70／74）、91．89％（68／74）和84．31%（43／51）。围手术期急性肝静脉血栓形成3例，肝穿刺道出血2例，肝包膜下血肿1例，肺栓塞1例，均经保守治疗痊愈，无致死性并发症发生。结论：采用经皮肝穿刺入路肝静脉腔内成形技术治疗膜性或节段性肝静脉型BCS技术简单、安全、有效，其中远期效果令人满意。     

经皮经腔血管成形术治疗布加氏综合征

目的探讨用介入学方法治疗布加氏综合征。方法先行经皮下腔静脉造影术,明确病变类型。对单纯狭窄型者采用球囊导管扩张术,然后置入血管内支架;对完全膜型或节段闭塞型者,先行穿刺破膜或开通,继而行球囊导管扩张术,节段型者同时置人血管内支架;对伴血栓形成者先行溶栓治疗。结果本组10例拟诊者,均行下腔静脉造影术,确诊布加氏综合征8例;共行下腔静脉球囊扩张成形术8例,下腔静脉穿刺破膜3例,穿刺开通2例,下腔静脉支架置人术7例,置入9枚支架。未出现下腔静脉破裂、腹腔内出血及肺栓塞等。结论经皮经腔血管成形术微创、安全、有效,应予推广。     

Fracture of inferior vena cava stent after endovascular treatment for Budd-Chiari syndrome: A case series and literature review

Budd-Chiari syndrome (BCS) is a rare condition characterized by hepatic venous outflow obstruction. Balloon angioplasty, with or without stenting, is the recommended first-line treatment modality in Asian countries. As a supplement to balloon angioplasty, expandable metallic Z-stent deployment can effectively improve long-term inferior vena cava (IVC) patency. Although stent placement is a standard and frequently performed treatment, very few IVC stent-related complications, such as stent fractures, have been reported. Here we present a case series and a comprehensive review of IVC stent fractures in patients with BCS. The most common characteristic of IVC stent fractures is a protrusion of the proximal segment of the IVC stent into the right atrium and its systolic and diastolic movements along with heart rhythms. Accurate stent deployment, large-diameter balloon dilation, patient breath-holding training, preferential selection of a triple stent, and the use of an internal jugular vein approach to stent deployment may ensure precise stent localization and avoid postoperative complications.     

不同类型的Budd—Chiari综合征的介入治疗

目的探讨不同类型Budd—Chiari综合征的介入治疗方法,评价经皮穿刺血管成形术、内支架植入术及血管内溶栓术治疗Budd—Chiari综合征的价值。方法7年中诊治Budd—Chiari综合征患者89例。针对不同的类型分另行下腔静脉球囊扩张术、下腔静脉球囊扩张联合血管内支架植入术、经颈静脉肝静脉成形术、经皮经肝联合经颈静脉行肝静脉成形术、下腔静脉和肝静脉双球囊扩张术、下腔静脉和肝静脉双支架植入术等介入治疗方法。结果介入治疗Budd—Chiari综合征的总的成功率为96％,术中无一例死亡及肺栓塞等并发症发生。严重的并发症包括误穿心包导致心包填塞和血管内支架脱落进入右心房。结论Ⅰa、Ⅱ及Ⅲ型只需行PTA治疗;Ⅰb型宜用TIPPS治疗,而Ⅳ型宜采用PTA加支架置入治疗;Ⅲ、Ⅳ型病例行血管成形术前充分溶栓是必要的;B超引导下经皮肝静脉穿刺可提高穿刺成功率、减少并发症。