不同类型的Budd—Chiari综合征的介入治疗

目的探讨不同类型Budd—Chiari综合征的介入治疗方法，评价经皮穿刺血管成形术、内支架植入术及血管内溶栓术治疗Budd—Chiari综合征的价值。方法7年中诊治Budd—Chiari综合征患者89例。针对不同的类型分另行下腔静脉球囊扩张术、下腔静脉球囊扩张联合血管内支架植入术、经颈静脉肝静脉成形术、经皮经肝联合经颈静脉行肝静脉成形术、下腔静脉和肝静脉双球囊扩张术、下腔静脉和肝静脉双支架植入术等介入治疗方法。结果介入治疗Budd—Chiari综合征的总的成功率为96％，术中无一例死亡及肺栓塞等并发症发生。严重的并发症包括误穿心包导致心包填塞和血管内支架脱落进入右心房。结论Ⅰa、Ⅱ及Ⅲ型只需行PTA治疗；Ⅰb型宜用TIPPS治疗，而Ⅳ型宜采用PTA加支架置入治疗；Ⅲ、Ⅳ型病例行血管成形术前充分溶栓是必要的；B超引导下经皮肝静脉穿刺可提高穿刺成功率、减少并发症。

PTA and stenting for various types of Budd-Chiari syndrome

Objective To investigate and evaluate PTA and stenting for various types of Budd-Chiari syndrome （BCS）. Methods 89 patients with BCS were diagnosed and treated during 7 years. The interventional procedures included： Percutanous balloon dilatation （PBD） of inferior vena cava （IVC）, PBD and stent placement for IVC, hepatic vein angioplasty via transjugular vein, hepatic vein angioplasty via transhepatic and transjugular approach, accessory hepatic vein angioplasty, percutanous dual balloon dilatation for IVC and hepatic vein, and percutanous dual stent placement for IVC and hepatic vein. Results The achievement ratio of PTA and stent placement was 96% and the mortality was 0%. The serious complication of PTA and stent placement of BCS was penetration into the pericardium, endovascula stent migration into right atrium. Conclusion 1. PTA is a reliable procedures in treating type Ⅰ a, Ⅱ and Ⅲ BCS, and TIPPS is useful for type Ⅰ b BCS. But PTA and stenting is necessary for patients with type Ⅳ BCS. 2.Thrombolysis is needed for patients with type Ⅲ, Ⅳ BCS. 3. Guiding of Color Doppler Ultrasound can improve the success ofpercutanous hepatic vein and reduce complications.