下腔静脉阻塞性病变介入治疗的围手术期处理

目的：分析138例下腔静脉阻塞性病变的治疗结果，探讨下腔静脉阻塞性病变介入治疗的围手术期处理。方法：本组：138例(男121例，女17例)，年龄27～78岁，平均56．3岁。下腔静脉阻塞病因：肿瘤压迫或侵及(120例)；原发性病变(布-加氏综合征18例)。术前造影证实：下腔静脉完全闭塞35例，狭窄程度≥90％ 79例，75％～90％ 24例。其中肝静脉同时受累15例。术前肝功能：Child C级47例(占34．1％)，Child B级71例(占51．4％)。方法：138例均行下腔静脉PTA 支架置放术，均为“GianturcoZ”支架，长度40～120mm。估计肝静脉狭窄或闭塞影响肝回流达65％以上7例，均行肝静脉PTA，3例行支架治疗。术后给予保肝、抗炎、强心、利尿、抗凝治疗。结果：138例术后造影示下腔静脉通畅，有效管径均≥15mm。术后急性期(2周)双下肢水肿明显缓解至完全消退占84．8％，尿量较术前明显增多占62．3％，肝功能由Child C级改善为B级者21．0％。改善率61．7％。死亡5例。结论：术前行实验室和影像学检查了解重要脏器的功能状态和腔静脉阻塞的程度，能为改善病人状况及术中选择操作方式提供依据；术后防治心衰，保护肝、肾功能，预防肺栓塞是减少并发症、降低死亡率的关键。

Peri-operative management for Interventional Therapy of Obliterative Hepato-cavopathy

Objective: To study the peri - operative management for interventional therapy of obliterative hepato - cavopathy by analyzing therapeutic results in 138 cases. Methods; To select 138 cases,including male 121cases,female 17 cases. Ages were from 27 to 78 years old.average 56.3 years old. Etiological factors of obliterati ve hepato - cavopathy were tumor compression or invasion(120 cases) ,primary disease(BCS 18 cases).Preoperative cavography demonstrated that 35 cases were complete oc-clusion, 79 cases' constrictive Ievel was greater than 90 % , 24 cases' constrictive Ievel was 75 % ~ 90 % . All cases were treated by PTA + EMS.Length of stent ranged from 40 to 120mm.7 cases whose hepatic vem outflow was reduced over 65% because of orifice obstuction of hepatic vein underwent PTA to obstructive hepatic vein, 3 Wallstent were implanted. Results: All IVC were recanalized successfully. The effective diameter of IVCs was greater than 15mm. The edema of lower extremity was allevi-ated or disappeared in 84.8% of patients within 2 weeks. The amount of urine increased in 62. 3% of patients. 61. 7% of pa-tients whose li ver function belong to Child C degree pre - operation changed to Child B degree post-operation.5 patients died after operation. Conclusion; It is very important to comprehend the the functional status of vi tai organs and obstructive degree of IVC before interventional procedure. The key point of reducing mortality and morbidity is to prevent and cure congestive heart failure.to safeguard hepatic and renal function and,to prevent pulmonary embolism.