降低副肝静脉压力在Budd-Chiari综合征治疗中的意义

目的:探讨降低副肝静脉(AHV)压力在Budd-Chiari综合征(BCS)治疗中的临床意义。方法:回顾性分析2007年3月—2015年7月收治的27例BCS患者资料,其中男11例,女16例,平均年龄(46±8)岁;AHV开口病变者9例,下腔静脉(IVC)病变者12例,AHV与IVC混合病变者6例。结果:所有患者均行AHV造影并测压以及腔内治疗。9例AHV病变患者行AHV球囊扩张成形术,术后AHV压力从(25±4)cm H_2O(1 cm H_2O=0.098 k Pa)降至(17±3)cm H_2O;12例单纯IVC病变患者中10例行IVC球囊扩张成形术,2例行开放手术,术后AHV压力从(27±6)cm H_2O降至(15±4)cm H_2O,肝段IVC压力从(27±5)cm H_2O降至(14±3)cm H_2O;6例混合病变患者术后AHV压力从(28±6)cm H_2O降至(14±4)cm H_2O,IVC压力从(26±5)cm H_2O降至(13±4)cm H_2O。所有患者术后3 d腹部症状均有明显缓解,IVC存在病变者,双下肢沉胀感明显减轻,治疗有效率100%;未出现出血和肺栓塞并发症;23例患者随访4~54个月,术后6个月时多普勒超声提示原有病变通畅率100%,后期2例出现IVC再闭塞,再次行球囊扩张治疗后症状好转。结论:降低AHV内压力有助于缓解BCS患者症状,应重视AHV的存在和病变的治疗。

Significance of accessory hepatic vein pressure reduction in treatment of Budd-Chiari syndrome

Objective: To investigate the clinical significance of accessory hepatic vein (AHV) pressure reduction in treatment of Budd-Chiari syndrome (BCS).Methods: The clinical data of 27 BCS patients treated during March 2007 to July 2015 were retrospectively analyzed. Of the patients, 11 cases were male and 16 cases were female, with an average of (46±8) years old; 9 cases had lesions in the opening of AHV, 12 cases had occlusion in the inferior vena cava (IVC) and 6 cases had mixed lesions of AHV and IVC.Results: All patients underwent venography and manometry of the AHV and endovascular treatment. Nine patients with AHV disease underwent balloon dilatation angioplasty of the AHV, and their preoperative AHV pressure dropped from (25±4) cmH2O to (17±3) cmH2O; in the 12 patients with IVC disease, 10 cases underwent balloon dilatation angioplasty of the IVC and 2 cases underwent open surgery, and the preoperative AHV and intrahepatic IVC pressure decreased from (27±6) cmH2O to (15±4) cmH2O and from (27±5) cmH2O to (14±3) cmH2O, respectively; in the 6 cases with both AHV and IVC involvements, the preoperative pressure of AHV and IVC declined from (28±6) cmH2O to (14±4) cmH2O and from (26±5) cmH2O to (13±4) cmH2O, respectively. The abdominal symptoms were significantly relieved 3 days after operation in all patients and the edema in lower limbs was remarkably alleviated in those with IVC lesion, with treatment effective rate of 100%. No complications such as bleeding and pulmonary embolism occurred. Twenty-three patients were followed up for 4 to54 months, doppler ultrasound at 6 months after operation showed that the patency rate of original lesion was 100% and, at a later time, IVC re-occlusion occurred in 2 cases which were resolved by second balloon dilatation. Conclusion: AHV pressure reduction can help to alleviate the symptoms of BCS patients, and attention should be paid to the existence of the AHV and the treatment of its problems.