经皮经肝肝静脉成形术治疗肝静脉阻塞型Budd-Chiari综合征

目的探讨和评价经皮肝穿刺入路肝静脉腔内成形(percutaneous transhepatic recanalization and angioplasty of hepatic vein,PTRAHV)治疗肝静脉型Budd-Chiari综合征(BCS)的可行性和中远期疗效。方法自1996年9月至2006年10月收治单纯肝静脉阻塞型及肝静脉阻塞伴有下腔静脉阻塞型BCS患者101例,在PTRAHV前后经导管测定患者肝静脉压力,观察围手术期并发症,并分别于术前、术后6个月彩超测量门静脉内径、平均流速和血流方向等,计算对比血流量,随访观察受干预血管的通畅率。结果技术成功率91.1%(92/101)。术中急性肝静脉血栓形成3例,术后发生肝穿刺道出血2例,肝包膜下血肿1例,肺栓塞1例,均经保守治疗痊愈,未发生致死性并发症。随访74例,术后6个月门静脉平均流速和血流量参数均高于术前(P<0.05);术后6个月、1年和2年的受干预血管的初始再通率分别为83.8%(62/74)、78.4%(58/74)和76.5%(39/51),其辅助再通率分别为94.6%(70/74)、91.9%(68/74)和84.3%(43/51)。结论采用PTRAHV技术治疗膜性或节段性肝静脉型BCS操作简单、安全、有效,其中远期效果令人满意。

Clinical study On percutaneous transhepatic angioplasty of hepatic veins in the treatment of Budd-Chiari syndrome with occlusion of hepatic veins

Objective To investigate and evaluate the feasibility and middle,long-term efficacies of percutaneous transhepatic recanalization and angioplasty of hepatic veins(PTRAHV)in the treatment of Budd-Chiari syndrome(BCS)with occlusion of hepatic veins. Methods From September 1996 to October 2006,101 Budd-Chiari syndrome patients with occlusion of hepatic veins or accompanied by occlusion of inferior vena cava were recruited for the clinical study,including 65 males and 46 females(average age 42.47 years). Free hepatic vein pressure(FHVP)were measured through catheterization pre and post-angioplasty. Periprocedural complications,portal venous indexes including vessel diameter,mean flow rate and the direction,and venous patency ratio were evaluated and compared by Color Doppler during follow-up. Results The successful ratio was 91%(92/101). During perioperative procedure,3 patients with acute hepatic vein thrombosis,2 with liver puncture tract bleeding,1 with subcapsular hematoma and 1 case with pulmonary embolism occurred but with no mortality after systemic conservative treatment. Follow-up of 6 months after PRTAHV were collected in 74 cases with portal venous indexes improvement over that of pre-procedure(P < 0.05),the primary patency ratios of involved hepatic veins was 83.78%(62/74),78.38%(58/74)and 76.47%(39/51)at 6 months,1 and 2 years after operation respectively,and the assisted patency ratios was 94.59%(70/74),91.89%(68/74)and 84.31%(43/51),respectively. Conclusions PTRAHV is safe and effective option for treatment of Budd-Chiari syndrome with membraneous and segmental hepatic lesions. The middle and long-term efficacies are promising.