布-加综合征并上腔静脉阻塞的处理

目的　探讨合并上腔静脉病变的布 -加综合征 (BCS)的治疗方法。方法　 3例术前均经彩色Doppler及血管造影确诊。 1例行腔房人工血管旁路 ,1例行下腔静脉破膜及扩张(PTA) ,1例行PTA及内支架置入 ;3例中 ,1例上腔静脉血栓延续至双侧颈内静脉者行溶栓治疗 ,余 2例上腔静脉病变未予处理。结果　 3例下腔静脉压力变化 :术前分别为 2 .40kPa、2 .16kPa、3.5 3kPa(平均 2 .98± 0 .12kPa) ,术后降至 0 .98kPa、1.2 7kPa和 1.0 8kPa(平均 0 .74± 0 .15kPa ,P <0 .0 5 )。随访 3月至 11年 ,2例症状及体征完全消失 ,1例明显缓解 ,均恢复正常生活及工作。结论　介入治疗是该类BCS的首选方法 ,其并存的局限性上腔静脉病变可不预处理。

Treatment of Budd - Chiari syndrome complicated with occlusion in the superior vena cava

Objective To investigate the therapy of Budd-Chiari syndrome(BCS) with lession of superior vena cava(SVC).Methed All of 3 cases were diagnosed with color Doppler and angiography.By pass operation with artificial blood vessels from the inferior vena cava(IVC) to right atrium was taken in 1 case.The rupture of membrane and dilatation of IVC plus putting stent in 2 cases was performed and then thrombolytic treatment was used in 1 case because of thrombosis in SVC continued to bilateral internal jugular vein and obsructive symptom did not relief.The lesion of SVC were not treated in the other.Result The pressure of IVC dropped from 2.98±0.12*!kPa(2.40*!kPa,2.16*!kPa and 3.53*!kPa,respectively) before operation to 0.74±0.15*!kPa(0.98*!kPa,1.27*!kPa and 1.08*!kPa,respectively)after operation(P<0.05).All of 3 cases were followed up from 3 months to 11 years,and the main symptoms and signs disappeared completely in 2 cases and partially alleviated in 1 case .Conclusion The interventional treatment is a first choice to the patients with BCS,and it is unnecessary to treat the lession of SVC for the patients.