经血管内溶栓和成形术治疗布-加氏综合征合并下腔静脉血栓形成

目的探讨经血管内溶栓加成形术治疗布-加氏综合征(Budd-Chiari syndrome,BCS)合并下腔静脉(IVC)血栓的应用价值。方法本组26例,采用经血管行IVC血栓内溶栓、大球囊成形术、球囊分次扩张加支架压迫血栓成形术;其中21例置管溶栓与我院早期18例全身静脉溶栓对照。结果造影发现26例IVC肝段上方呈膜性孔型狭窄或闭塞,膜下血栓形成。21例行IVC置管溶栓,溶栓效果明显高于全身静脉溶栓(P<0.01);7例血栓消失后行球囊成形术,14例血栓缩小后行球囊加支架成形术。5例急症患者行球囊加支架成形术。24例治疗成功,成功率92.3%。术前下腔静脉压力(28±6)cmH2O,术后压力(14±4)cmH2O,术前术后下腔静脉压力下降明显(P<0.05)。并发症2例,1例内支架闭塞,1例肺栓塞,占7.7%。随访3-72个月,平均36个月,20例临床症状和体征消失,5例明显缓解,1例3个月后再次上消化道出血死亡。结论介入治疗BCS合并IVC血栓具有微创性、可重复、安全有效,成为主要的治疗方法。

Thrombolysis in inferior vena cava with PTA and stent in Budd-Chiari Syndrome patients complicated with thrombosis

Objective To evaluate the effect of PTA and stent after thrombolysis in inferior vena cava for Budd-Chiari Syndrome(BCS) patients complicated with thrombosis.Methods Twenty-six BCS patients complicated with thrombosis were treated with thrombolysis in inferior vena cava or in thrombosis using urokinase before PTA and/or stent,and twentyone patients compared with eighteen patients thrombolysis by intravenous.Results 26 patients with suprahepatic obstruction or occlusion of inferior vena cava were confirmed by angiography,and complicated with thrombosis.21 patients treated with thrombolysis in inferior vena cava had an good effect than thrombolysis by intravenous(P<0.01);7 patients with thrombosis completely disappeared treated with PTA only,14 patients with thrombosis partially disappeared treated with PTA and stent.5 patients treated with PTA and stent in emergency.Patients followed 3 to 72 months(mean 36 months),had an effective rate of 92.3%.The main symptoms and signs completely disappeared in 20 cases,partially disappeared in 5 cases.Two patients had complications,one with occlusion in stent,another with pulmonary embolism and died.Conclusion Thrombolysis in inferior vena cava with PTA and stent was an effective and safe method in treatment BCS patients complicated with thrombosis.