直接性肝内门腔分流术在布加综合征中的应用

目的:探讨直接性肝内门腔分流术(DIPS)治疗布加综合征(Budd-Chiari syndrome，BCS)的疗效。方法:回顾性分析2015年1月1日至2017年6月31日于北京世纪坛医院介入治疗科、北京友谊医院肝病中心及北京地坛医院普通外科接受DIPS治疗的BCS患者临床资料，包括患者病史、体征如腹胀、腹水、肝脏肿大...

Direct intrahepatic portosystemic shunt in treatment of Budd-Chiari syndrome

Objective To study the efficacy of direct intrahepatic portosystemic shunt(DIPS)in treatment of Budd-Chiari syndrome(BCS).Methods From January 1,2015 to June 31,2017,consecutive patients with BCS who were treated with DIPS at the Department of Interventional Therapy of Beijing Shijitan Hospital,the Liver Disease Research Center of Beijing Friendship Hospital and the General Surgery Department of Beijing Ditan Hospital were retrospectively analyzed.The symptoms,physical signs(including abdominal distension,ascites,pleural effusion,splenomegaly,hepatic encephalopathy)and perioperative laboratory results of these patients were collected and analyzed.Biochemical indicators including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),direct bilirubin(DBil),and portal pressure gradient were compared before and 2 weeks after treatment.The patients were followed up for at least 3 years to assess their clinical symptoms,patency of shunt,oncological status and survival.Results Of 67 patients with BCS who were included in the study,there were 45 males and 22 females,aged(38.12±23.22)years.The BCS classification of these patients were hepatic vein type(n=65),including 62 patients with complete hepatic vein obstruction,3 patients with hepatic vein occlusion due to thrombosis,and 2 patients with mixed hepatic vein and inferior vena cava occlusion.All 67 patients underwent DIPS with 93 stents being implanted.In addition,43 patients underwent gastric coronary vein embolization,and 2 patients with mixed type of BCS underwent inferior vena cava stenting.The portal pressure gradient decreased from(22.17±9.16)mmHg(1 mmHg=0.133 kPa)to(9.87±4.75)mmHg,the difference was statistically significant(P<0.05).Abdominal distension was relieved,at one month and ascites completely subsided in 3 months after operation.The liver congestion and swelling were obviously relieved.Comparison of patients 2 weeks after operation and before operation,ALT decreased from(65.28±27.75)U/L to(28.43±13.46)U/L,AST from(68.75±29.23)U/L to(26.92±13.33)U/L,TBil from(175.31±80.48)μmol/L to(45.08±26.54)μmol/L,DBil from(127.55±44.65)μmol/L to(35.12±10.77)μmol/L,and albumin increased from(31.56±7.22)g/L to(44.18±11.36)g/L,the difference was statistically significant(all P<0.05).All patients were followed up for at least 3 years.Shunt stenosis was detected in 5 patients(7.46%)with shunt expansion being performed,variceal bleeding in 2 patients(2.99%),ascites recurrence in 4 patients(5.97%)and hepatic encephalopathy in 2 patients(2.99%).No patients were diagnosed with hepatic cancer,and no patients died.Conclusion DIPS was efficacious,safe and reliable to that BCS patients.It rapidly reduced portal venous pressure,relieved liver congestion,and restored liver morphology and liver function in these patients.