B超导向经皮经腔血管成形治疗Budd－Chiari综合征的临床研究

Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的诊断和治疗目前仍是一个难题，常规手术治疗并发症多、死亡率高。我们自１９９１年３月～１９９４年４月，Ｂ超导向经皮经腔血管成形术（ＰＴＡ）治疗Ｂｕｄｄ－Ｃｈｉａｒｉ综合征５６例（其中２例为手术后复发患者），男３４例、女２２例，年龄１９～５３岁，病程５～２２年，９８．１０％（５５／５６）有肝病诊治病史，９１．０７％（５１／５６）肝大，上腹胀满心悸乏力。对隔膜性或局限性腔静脉狭窄或阻塞，均直接在Ｂ超导向下行球囊下腔静脉成形术。５６例中５１例１次扩张成功、２次扩张成功者２例、２例失败、１例死亡，总成功率９４．６４％（５３／５６）。扩张后即刻血流动力学检查：下腔静脉压力由扩前３．３５±０．５１ｋＰａ（３４．２５±５．２４ｃｍＨ＿２Ｏ）降至１．３６±０．２３ｋＰａ（１３．４６±２．３６ｃｍＨ＿２Ｏ）（Ｐ＜０．００１），右房压力扩前０．３２±０．２４ｋＰａ（３．２７±２．４１ｃｍＨ＿２０）升至１．３１±０．２２ｋＰａ（１３．４６±２．３２ｃｍＨ＿２Ｏ）（Ｐ＜０．００１），跨窄压差由扩张前２．６９±０．４８ｋＰａ（２７．５０±４．９２ｃｍＨ＿２０）降至０．３４±０．２３ｋＰａ（３．５０±２．３７?

B-ULTRAS0UND GUIDED PTA F0R BUDD-CHIARI SYNDROME──A CLINICAL STUDY

Budd-Chiari syndrome,untill now,is still difficult of diagnosis and treatment.Conventional operative therapy is usually accompanied by various complications and highmortality.Since March 1993,under the guidance of B-Ultrasound we used percutaneoustransluminal angioplasty(PTA)for Budd-Chiari syndrome.To April 1994,56 cases were un-dergone with this method(2 were postoperative recurrencer).34 men,22 women,age rangedfrom 19 to 53 years,illness history ranged from 5 to 22 years.98.10%(55/56)of the caseshad gone through treatment as hepatic diseases,91.07%(51/56)of them had hepatomegly,upper abdominal discomfort,palpitation and fatigue.Albthe patients whose inferior venu cavastenosis according to examination belonged to diaphragmatic or segmental type were under-gone PTA under the guidance of B-Ultrasound.Of 56 cases 51 were cured successfully byonce intraluminal dilatation,2 cases by twice,2 cases failed,one case died.Total success di-latation rate achieved 94.64%.The hemodynamic data determined immediatly before and af-ter dilatation show as follow.The pressure of inferior venu cava was lowered frorn 3.35 ±0. 51 kPa(34.25±5.24 cmH_20)in predilatation to 1.36±0.23 kPa(13.46±2.36cmH_20) inpostdilatation (P<0.001 ).Right atrium pressure was increased from 0.32±0.24 kPa(3.27±2. 41 cmH_2O)in predilatiation to 1.31±0.22 kPa(13.46±2.32 cmH_2O)in postdi-latation(P<0. 001).The pressure difference across stenosis was lowered from 2.69 ±0.48 kPa(27.50±4.92 cmH_20) in predilatation to 0.34±0. 23 kPa(3. 50±2. 37 cmH_2O)inpostdilatation(P<0.001).After treatment with PTA, The patient’s urin incerased,Theirmegalohepatia and varicose veines in the thoracic and abdominal wall returned to normal. Selffeeling improved,Following up 4 to 32 mounthes,no recurrence were found in 96. 23%(51/53)of the revivers.