500例Budd-Chiari综合征介入治疗并发症分析

目的 探讨Budd—Chiari综合征(BCS)介入治疗术中及术后并发症发生的原因及预防措施。方法 1990—2002年接受介入治疗的BCS患者共500例，其中腔静脉阻塞型337例、肝静脉阻塞型77例、混合型86例。所有病例均行经皮穿刺球囊扩张术(PTA)，其中120例还做了血管内支架置入术。结果 发生介入治疗并发症共58例(11．6％)，死亡1例(0．2％)。术中并发症有误穿心包和心包填塞9例(1．8％)，其中心包填塞3例(死亡1例)；金属内支架脱落入右心房2例(0．4％)；胸腔出血1例(0．2％)；腹腔出血2例(0．4％)。术后并发症为急性再狭窄27例，其中单纯PTA后22例(5．8％，22／380)，PTA 内支架置入术后再狭窄5例(4．2％，5／120)。穿刺部位形成假性动脉瘤3例(0．6％)；穿刺点出血和局部血肿形成10例(2．0％)；穿刺侧下肢静脉血栓形成4例(0．8％)。结论 介入治疗BCS是1种安全有效的方法，应采取各种有效措施避免和减少并发症的发生。

Analysis of complications in interventional therapy of 500 cases with Budd-Chiari syndrome

Objective To discuss the causes and preventive measures of the peri- and postoperative complications of interventional therapy in treating Budd-Chiari syndrome (BCS). Methods From 1990 to 2002, a total of 500 cases with BCS treated with interventional therapy were included in this study. 120 of them received both percutaneous transluminal balloon dilatation and endovascular stent (PTA+stent), and the other 380 cases were treated by percutaneous transluminal balloon dilatation (PTA) alone. Results The incidence of complication was seen in 58 cases (11.6%), and the death rate was 0.2% in the interventional therapy of BCS. The perioperative complications included puncture into pericardium (n=9, 1.8 %), including 3 cases with pericardial effusion (one died); migration of the stent into the right atrium (n=2, 0.4%); thoracic hemorrhage (n=1, 0.2 %), and abdominal hemorrhage (n=2, 0.4 %). The postoperative complications included acute restenosis of the treated vessel formation (n=27) including 22 cases (5.8%, 22/380) in simple PTA and 5(4.2%, 5/120) after PTA+stent, pseudoaneurysm (n=3, 0.6 %), hematoma (n=10, 2.0%) at the puncture site, and thrombosis of the limb (n=4, 0.8 %). Conclusion The interventional therapy of BCS is a safe and effective method. Effective measures should be taken to evade and reduce the occurrence of the complications.