Transjugular percutaneous inoue balloon mitral commissurotomy in a patient with inferior vena cava obstruction after liver transplantation.

Percutaneous transvenous mitral commissurotomy was performed successfully via the transjugular approach in a patient with severe rheumatic mitral stenosis and obstruction of the inferior vena cava due to prior liver transplantation. This case demonstrates the advantage of the jugular approach in patients with difficult anatomy.     

Transjugular intrahepatic cavoportal shunt for Budd–Chiari syndrome

Budd–Chiari syndrome (BCS) is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for BCS are limited. We report a case of a 21-year-old woman with protein S and C deficiency with gross ascites. Treatment with transjugular intrahepatic portosystemic shunt (TIPS) was attempted, which revealed occluded hepatic veins, so transcaval TIPS was performed. No serious procedure-related complication occurred. After successful shunt creation, the patient's symptoms subsided and she was discharged and followed up for 6 months.     

脑立体定向术临床应用

目的：探讨以脑立体定向术治疗震颤麻痹、癫痫、癌性疼痛、慢性精神病及颅内金属异物的方法和疗效。方法：用多功能脑立体定向仪对不同疾病毁损其不同的核团。结果：震颤麻痹１６６例共１８２次手术中治愈１３例次，显效１４５例次，有效１１例次，无效１２例次，死亡１例，有效率达９２９％；癫痫１８例，显效１１例，有效４例，无效３例，有效率达８３３％；癌性痛疼５例均显效；精神病３例，显效２例，有效１例；颅内异物２例均治愈。结论：脑立体定向术对以上疾病均取得了较为满意及良好的疗效，总有效率达９２４％，并且比传统开颅术简便安全     

腔内血管技术在肝静脉回流障碍综合征治疗中的应用

目的：探索一种简单、安全、有效的治疗肝静脉回流障碍（Budd-Chiari)综合征的新方法。方法：在11例肝静脉回流障碍综合征患中,应用经皮穿刺下腔静脉气囊扩张成形术治疗获得成功后,有9例患同时置入血管内支架。3例肝静脉完全闭塞在下腔静脉腔内治疗术成功后1周内行肠系膜上静脉－下腔静脉间人造血管“H”型分流术。结果：11例患,除1例在腔内治疗后出现轻度心功能不全表现外,无手术并发症,术后随访6－35个月,血管内支架通畅、无移位,分流血管无血栓栓塞,门脉高压症状明显缓解,患生活质量提高。结论：腔内血管技术是肝静脉回流障碍综合征的首选治疗方法。     

静脉内支撑治疗布-加综合征

目的：评估静脉内支撑治疗布－加（Ｂｕｄｄ－Ｃｈｉａｒｉ）综合征的应用价值。方法：①下腔静脉完全梗阻者,根据阻塞长度置入可扩张性内支撑架;②门静脉高压者,在下腔静脉球囊扩张的同时行颈内静脉肝内门体分流术（ＴＩＰＳＳ）治疗后再置入内支撑架;③肝静脉狭窄或闭塞者,扩张肝静脉远端后再植入内支撑架。结果：所有患者均获得操作成功。手术后临床症状明显改善,下腔静脉压差和门静脉压力显著下降。随访８例下腔静脉内支撑和肝内门体分流道通畅良好。结论：静脉内支撑治疗布－加综合征疗效良好     

Long-Term Outcomes of Endovascular Interventions in More than 500 patients with Budd–Chiari Syndrome

PurposeTo assess and compare the long-term outcomes of various endovascular interventions in patients with Budd-Chiari syndrome (BCS).Materials and MethodsIn this single-center retrospective study, 510 consecutive patients with BCS who had undergone a total of 618 endovascular procedures from January 2001 to December 2019 were included. Details of the type of endovascular intervention, technical success, clinical success, patency rate, complications, and survival outcomes were analyzed.ResultsThe overall technical success rate was 96% (593 of 618 procedures; 500 in treatment-naïve patients and 93 repeat interventions for recurrent disease). Endovascular procedures included recanalization procedures (angioplasty and stent placement) in 355 patients (71%) and transjugular intrahepatic portosystemic shunt (TIPS) creation in 145 (29%). Major postprocedure complications occurred in 14 patients (2.8%). Vascular/stent restenosis occurred in 95 patients (19%), and successful repeat intervention was performed in 82 of those 95 (86.3%). An additional 11 of these 82 (13.4%) underwent a third intervention for restenosis. In the recanalization and TIPS groups, the 1- and 5-y cumulative patency rates were 87% and 74% and 95% and 68%, respectively. The 1- and 5-y survival rates were 96% and 89% and 90% and 76%, respectively.ConclusionsEndovascular interventions for BCS are feasible and safe in the majority of patients, with excellent short- and long-term patency and survival rates.     

球囊扩张合并支架置入治疗肝静脉阻塞型布-加综合征疗效观察

目的 观察球囊扩张合并支架置入治疗单纯肝静脉阻塞型布-加综合征(Budd-Chiari-syndrome,BCS)的疗效.方法 2001年7月至2006年9月采用多普勒超声引导下经皮经肝穿刺肝静脉并肝静脉造影术、经颈静脉行肝静脉成形术、肝静脉球囊扩张及支架置入术治疗肝静脉阻塞型BCS患者43例.结果 术前43例肝静脉平均压力为32.5 cm H2O(1 cm H2O=0.098 kPa),支架置入后立刻下降为20 cm H2O(t=11.5,P＜0.01),再次肝静脉造影显示肝静脉支架通畅,肝内肝静脉侧支消失.其中38例症状立刻消失,5例部分好转.术后43例随访期间(1～62个月,平均31.5个月),1例出院后1个月因上消化道大出血死亡,其余42例症状体征均无再发,术后多普勒超声检查肝静脉均通畅.治疗成功率为100%,所有患者均未出现严重并发症.结论 多普勒超声引导下经皮经肝穿刺肝静脉和经颈静脉途径开通肝静脉,球囊扩张成形及支架置入治疗单纯肝静脉阻塞型BCS安全、有效.