摘要
目的探讨肝静脉球囊扩张支架置入术治疗下腔静脉长段闭塞型布加综合征（Budd-Chiari syndrome，BCS）的意义。方法对40例下腔静脉长段闭塞型BCS经彩超、CT、MR对肝静脉情况进行评估后，先经颈静脉行膈上段下腔静脉造影，观察有无肝静脉开口，再用椎动脉导管结合超滑导丝寻找肝静脉；显示肝静脉后，行肝静脉球扩、支架术。结果40例BCS中，29例为肝静脉开口处隔膜或主干的短段闭塞，其中隔膜5例、主干短段闭塞24例，成功地对28例进行了肝静脉的介入治疗，其中单纯球扩5例，球扩加支架23例，1例穿刺失败。另11例为肝静脉的广泛阻塞无法行肝静脉的介入治疗。随访26例，平均随访（24．0±1．3）个月，症状复发5例（19．2％），彩超见肝静脉再狭窄或闭塞6例（23％）。结论下腔静脉长段闭塞，多数肝静脉病变仅是开口处隔膜或主干的短段闭塞，采用颈静脉入路行肝静脉球扩支架的方法，可以解除肝静脉梗阻、缓解门静脉高压。
Objective To evaluate balloon angioplasty and stenting of the hepatic veins for the treatment of Budd-Chiari syndrome with long segmental inferior vena cava （IVC）. Methods The hepatic veins were evaluated by colour Doppler, CT or MR. Epidiaphragmatic inferior vena cavography was performed to locate the stenosed opening of the hepatic veins, in case of membrane occlusion of the hepatic veins, a puncture was attempted with Rups100 needle and then balloon dilation of the hepatic veins and stents implantation was carried out. Results In 40 cases of long segmental inferior vena cava （IVC） occlusive Budd-Chiari syndrome, membranous obstruction of the hepatic veins was found in 5 cases and short-segmental occlusion in 24 cases. 28 cases were successfully treated with balloon dilation and stents implantation, including percutaneous transluminal angioplasty （PTA） of hepatic vein in 5 cases, and stent implantation in 23 cases, puncture procedure was failed in 1 case. Postoperative follow-up was made in 26 cases from 6 to 62 months （ mean, 24. 0 ± 1.3 months）. Symptoms recurred in 6 cases. Hepatic vein restenosis or occlusion were observed using color Doppler ultrasound in 6 cases. Conclusions Most lesions in hepatic veins were membranous obstruction or short-segmental occlusion among patients with long- segmental occlusion of IVC . Balloon angioplasty and stenting of hepatic veins for long segmental IVC occlusive Budd-Chiari syndrome through jugular vein can relieve hepatic venous obstruction and relieve portal hypertension.
出处
《中华普通外科杂志》
CSCD
北大核心
2012年第7期551-553,共3页
Chinese Journal of General Surgery
