Budd—chiari综合征造影血流动力学变化与介入治疗方法的选择

作者通过下腔静脉或(和)肝静脉造影及B超检查,对41例Budd—chiari综合征血流动力学进行了研究,并结合介入治疗本病的经验体会,提出新的分型及可供选择的治疗方法。Ⅰ型:单纯肝静脉阻塞以球囊扩张为主,如狭窄解除不满意置入内支架,如为肝小静脉泛发性狭窄,可作为TIPSS的适应症。Ⅱ型,膜性或节段性不全阻塞,以球囊扩张为主,选择置入内支架。Ⅲ型:膜性完全阻塞,采用穿通术及球囊扩张。Ⅳ型:节段性完全性闭塞,采用穿通术,球囊扩张及内支架置入。Ⅴ型:伴有多发性下腔静脉膜性或节段性阻塞,以球囊扩张为主,选择性置入内支架。 Ⅱ、Ⅲ、Ⅳ、Ⅴ型如合并肝静脉阻塞需开通肝静脉,如其中1支通畅,肝内侧支循环建立良好,其它肝静脉可不做处理;同样如三支肝静脉均不通,肝内侧支循环建立好,只需开通其中1支肝静脉即可。如下腔静脉节段性闭塞合并肝静脉不通,而肝外侧支循环建立较好,可主要处理肝静脉;如侧支循环建立不好,肝静脉、下腔静脉均应处理。

According to Budd - Chiari Syndrome Hemodynamics on Venography to Choose Interventional Treagment Method

The hemodynamics of Budd - chiari syndrome are complicated on the basis of our experience, we offer the newly classification and the related interventional treatment Type I pure occiusion in hepatic veins, balloon dilatation and /or stent planting in the serious cases, if there were extensive hepatic veins stenosis it would be fit for tipss. Type I ,membraneous or segmental partial occlusive lesions in inferior vena cava (IVC) balloon dilatation and /or stent planting in some selective cases. Type III, Entire membraneous occlusion in IVC, Re-canalization and balloon dilatation. Type IV , segmental IVC entire occlusion, Recanalization, balloon dilatation and stent planting. Type V, Extensive occlusive disease in IVC balloon dilatation and/or stent planting in selective cases. IVC lesions accompanied by hepatic veins stenosis or occlusive lesion, recanalization for the hepatic veins, if I of the 3 branches is patent and there is a good intrahepatic collaterall circulation, the other 2 branches needn't to be managed. if there are segmental occlusion in IVC and hepatic veins and there is a good ex-trahepatic collateral circulation. We manage the hepatic veins mainly if the collaterall circulation is not good then we manage both the hepatic veins and IVC