肝静脉型布加综合征的介入治疗（附8年随访结果）

目的评价肝静脉型布加综合征（BCS）的介入治疗效果及其预后。方法回顾性分析2005年1月至2013年12月期间于郑州大学第一附属医院接受介入治疗的94例肝静脉型BCS患者的临床资料。结果 94例肝静脉型BCS患者中,有93例的目标肝静脉开通成功,1例开通失败,开通成功率为98.94%。93例成功开通肝静脉患者中,有91例行球囊导管扩张成形术,2例行球囊导管扩张成形＋血管内支架置入术;1例合并原发性肝细胞肝癌患者于开通肝静脉后行肝癌切除术。术后发生并发症6例（6.38%）,其中1例（1.06%）于术后第2天发生腹腔内大出血,最终死亡。肝静脉开通成功的93例患者中,除2例失访外,91例均完成随访,随访率为97.85%;随访时间为1-96个月、（49.72±28.60）个月。随访过程中,1例患者于术后2个月因腹腔内大出血死亡,3例患者发生原发性肝细胞肝癌。8例患者目标肝静脉发生再次阻塞（11例次）,总体复发率为11.83%（11/93）,除1例行外科手术外,其余患者行介入治疗再次开通。本组患者的1、2、3及5年目标肝静脉原发通畅率分别为97.47%（77/79）、94.20%（65/69）、91.67%（55/60）以及91.67%（33/36）,1、2、3及5年目标肝静脉二次通畅率分别为98.73%（78/79）、98.55%（68/69）、98.33%（59/60）及97.22%（35/36）。结论以介入方法治疗肝静脉型BCS安全而有效,并发症发生率低,中期疗效满意。术后应注意目标肝静脉的随访,同时严密观察有无肝细胞肝癌发生。

Interventional Therapy for Budd-Chiari Syndrome Secondary to Hepatic Venous Obstruction with 8-Year Follow,Up

Objective To evaluate the applicability and the long-term outcomes of percutaneous transluminal balloon angioplasty （PTBA） in the management of Budd-Chiari syndrome （BCS） secondary to hepatic venous obstruction. Methods Clinical data of 94 patients with BCS secondary to hepatic venous obstruction who underwent PTBA of the hepatic vein from Jan. 2005 to Dec. 2013 in The First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Results PTBA were technically successful in 93 of the 94 patients （98.94%）. Ninety-one of the 93 patients （97.85%） were treated with PTBA alone and 2 patients （2. 15%） were treated with PTBA and stent. One patient with primary hepatocellular carcinoma （HCC） underwent resection of liver cancer after interventional therapy. Hepatic venous pressure value of 93 patients was significantly decreased after balloon interventional procedures. Symptoms were significantly improved in the 93 patients who had successful PTBA. Procedure-related complications occurred in 6 of the 93 patients （6. 38%）, and 1 patient （1.06%） died in 2 months after operation because ofintra-abdominal bleeding. Two patients lost during follow-up with a follow-up loss rate of 2. 15% （2/93）, and the 91 patients were followed-up for 1-96 months [ （49.72±28.60） months）. HCC occurred in 3 patients during follow-up period. Restenosis of targeted hepatic vein developed in 8 patients （11 times）, and the overall recurrence rate was 11. 83% （11/93）. One patient of them underwent surgical operation, the remaining 7 patients underwent PTBA successfully. The 1-, 2-, 3-, and 5-year primary patency rates were 97.47% （77/79）, 94. 20% （65/69）, 91.67% （55/60）, and 91.67% （33/36）, respectively. The 1-, 2-, 3-, and 5-year secondary patency rates were 98.73% （78/79）, 98.55% （68/69）, 98.33% （59/60）, and 97.22% （35/36）, respectively. Conclusions PTBA is a safe and effective treatment for BCS with the hepatic vein obstruction and had good mild-te