Budd-Chiari综合征合并下腔静脉长节段血栓及上消化道出血的介入治疗

目的探讨Budd-Chiari综合征(BCS)合并下腔静脉长节段血栓及上消化道出血的介入治疗方法,评价下腔静脉多支架顺序置入固定血栓+下腔静脉成形术+肝静脉成形术的治疗价值。资料与方法搜集2009年1月至2011年3月6例BCS合并下腔静脉长节段血栓及上消化道出血患者。上消化道出血控制稳定1周后,均以如下介入方法治疗:下腔静脉多支架顺序置入固定血栓+下腔静脉成形术+必要时肝静脉成形术。术后予以抗凝并随访。结果 6例患者以下腔静脉多支架顺序置入压迫血栓+下腔静脉成形术+必要时肝静脉成形术治疗,均获成功。近中期临床疗效明显。主要并发症为无症状性肺栓塞,共2例。无手术致死病例。结论下腔静脉多支架顺序置入固定血栓+下腔静脉成形术+肝静脉成形术,对治疗BCS合并下腔静脉长节段血栓及上消化道出血是安全、有效的,可以作为BCS伴下腔静脉长节段血栓及上消化道出血的治疗选择。

The Interventional Treatment on Budd Chiari Syndrome with Long Segmental Inferior Vena Cava Thrombosis and Upper Gastrointestinal Haemorrhage

Objective To investigate the interventional procedure on Budd Chiari syndrome(BCS) with long segmental inferior vena cava thrombosis and upper gastrointestinal haemorrhage,and evaluate the therapeutic value of multiple inferior vena cava stent placement for fixing thrombosis,inferior vena cava angioplasty and hepatic vein angioplasty.Materials and Methods From January 2009 to March 2011,6 patients who had BCS with long segmental inferior vena cava thrombosis and upper gastrointestinal haemorrhage received interventional treatment.About 1 week after upper gastrointestinal bleeding was controlled,all patients received multiple inferior vena cava stent placement for fixing thrombosis,inferior vena cava angioplasty and hepatic vein angioplasty.All patients accepted anticoagulant therapy and were followed up after procedures.Results The procedures of 6 patients were all successfully done.Recent and midterm clinical efficacies were significant in 6 patients.The main complication was asymptomatic pulmonary embolism in 2 cases.No mortality case was occurred related to the procedures.Conclusion It is safe and effective that patients of BCS with long segmental inferior vena cava thrombosis and upper gastrointestinal haemorrhage were treated by multiple inferior vena cava stent placement for fixing thrombosis,inferior vena cava angioplasty and hepatic vein angioplasty.