副肝静脉成形术在Budd-Chiari综合征治疗中的应用

目的 评价副肝静脉成形术经皮腔内血管成形术（PTA）及支架置入术]在Budd-Chiari综合征（BCS）介入治疗中的价值。方法 本组14例BCS患者均为肝静脉，副肝静脉狭窄或闭塞，主要症状和体征为腹胀，腹痛，腹水，肝脾肿大等，均接受了副肝静脉成形术，采用经股静脉或经颈静脉和经皮经副肝静脉途径开通副肝静脉的方法。结果 14例BCS开通副肝静脉均获得成功，未发生严重并发症，术后临床治愈7例，有效5例，无效2例。随访3-48个月。3例PTA后再狭窄（支架内血栓形成1例），1例术后2个月死于消化道大出血。结论 开通副肝静脉有着与开通肝静脉同等的治疗价值。易于操作，且更加安全，适应证为：（1）肝静脉和副肝静脉同时闭塞，而且肝静脉为节段性闭塞；（2）副肝静脉明显代偿性扩张，其管径大于8mm。

Budd-Chiari syndrome: accessory hepatic vein PTA and stent

Objective To evaluate percutaneous transluminal angioplasty (PTA) and stent in accessory hepatic vein (AHV) for Budd-Chiari syndrome (BCS). Methods Fourteen cases (male 5 and female 9, age from 23 to 56 years old) with BCS were treated with PTA and stent placement, all of which had stricture or occlusion of hepatic/accessory hepatic vein. The main clinical symptom was abdominal distention in all patients and mild abdominal pain in some patients. Percutaneous puncture from both femoral or jugular veins and percutaneous AHV approach was usually used. The modified Ginturco Z stent was employed in 8 cases. Results Technical successful rate in recanalization of AHV was 100% and no serious complications were noted. The symptoms were gradually relieved in 12 cases. The clinical effective rate was 85.7%. All cases were followed up for 3-48 months. Restenosis occurred in 2 cases. One died of severe gastric bleeding and one developed thrombus in the stent. Conclusion Recanalization of the AHV has the same treating value for BCS compared to recanalization of the hepatic vein(s), and the procedures of the former are easier and safer than those of the latter. The authors stressed on AHV anatomy and its clinical significance in treating BCS as well as its indications and effects. We think the indications are as follows: (1) occlusion of accessory hepatic vein and segmental occlusion of hepatic vein at the same time (2) obvious compensatory distension of accessory hepatic vein, with the diameter of 8 mm at least.