[1]张小明　 汪忠镐①　 张学民　 李伟　 李清乐　 蒋京军　 焦洋.布加氏综合征的介入治疗(143例经验总结)[J].中国微创外科杂志,2002,02(6):369-371.
　ZhangXiaoming,Wang Zhong gao,Zhang Xuemin,et al.Interventional treatment of Budd-Chiari syndrome (A report of143cases)[J].Chinese Journal of Minimally Invasive Surgery,2002,02(6):369-371.
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布加氏综合征的介入治疗(143例经验总结)()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
02
期数:
2002年6期
页码:
369-371
栏目:
出版日期:
2002-12-31

文章信息/Info

Title:
Interventional treatment of Budd-Chiari syndrome (A report of143cases)
作者:
张小明　 汪忠镐①　 张学民　 李伟　 李清乐　 蒋京军　 焦洋
北京大学人民医院心血管外科,北京,100044
Author(s):
ZhangXiaoming;  Wang Zhong gao;  Zhang Xuemin;  et al.
Department of Cardiovascular Surgery, Peking University People’s Hospital, Beijing 100044, China
关键词:
布加氏综合征 支架 下腔静脉
Keywords:
Budd-Chiari syndrome　Stent　Inferior vena cava(IVC)
分类号:
R657.3+4
文献标志码:
A
摘要:
目的总结介入方法治疗布加氏综合征143例的临床经验. 方法男92例,女51例.年龄6岁～65岁,平均34.8岁.共6种病理类型:①下腔静脉(Inferior Vena Cava,IVC)完全阻塞71例;②IVC狭窄36例;③IVC膜性阻塞伴小孔29例;④肝静脉(HV)膜性阻塞3例;⑤近期IVC血栓形成4例;⑥以上IVC病例中同时合并HV阻塞14例.治疗方法包括:(1)经股静脉行IVC破膜扩张或狭窄扩张77例;(2)经股静脉行IVC破膜扩张或狭窄扩张后IVC支架置入术62例;(3)经皮经HV破膜扩张3例;(4)经股静脉行IVC置管溶栓4例;(5)介入治疗后附加降低门脉高压手术16例. 结果介入治疗成功率90.2%(129/143),IVC压力下降范围(3～29)cmH2O,平均12.1cmH2O.发生并发症8例,肺栓塞、支架迁移及支架术后HV阻塞各2例,心包填塞和血胸各1例.死亡5例,2例死于肺栓塞,3例IVC支架术后二期附加肠腔侧侧分流术后死于肝昏迷,围手术期死亡率3.5%(5/143).单纯IVC扩张病例复发率10.4%,IVC扩张加支架置入术病例复发率1.6%,其余各组尚无复发者. 结论①IVC或HV局限性病变且无继发新鲜血栓者,应首选行破膜扩张术.②IVC破膜扩张后出现弹性回缩或复发者应行IVC支架术.③IVC病变合并HV闭塞者,IVC介入治疗后可附加降低门脉高压手术.
Abstract:
Objective　To sum up our clinical experience in interventional treatment of 143 cases of Budd- Chiari syndrome.　Methods　This study included 92 males and 51 females, aged from 6 to 65 years old with an av- erage of 34.8 years. The pathologic types were composed of complete occlusion of inferior vena cava (IVC) (71), IVC stenosis (36), IVC membrane occlusionwith a hole (29), membrane occlusion of hepatic vein (HV) (3), IVC thrombosis (4), and IVC lesions forementioned combinedwithHVocclusion (14). Therapeutic methods included that I: Percutaneous transinferior vena cava membranotomy and occlusion dilatation (PTA) (77); II: IVC PTAwith stent (62); III: Percutaneous transhepatic vein recanalization (3); IV: IVC thrombolysis through a catheter (4); V: Ad- ditional operation after intervention (16).　Results　The range of reduced IVC pressurewas (3 ~ 29) cmH2Owith the mean pressure being 12.1 cmH2O. Complications occurred in 8 cases, including pulmonary embolism (PE), stent migration andHVocclusion after IVC stent (2 cases respectively), cardiac tamponade and hemothorax (1 case repec- tively). 2 cases died of PE and 3 cases died of hepatic coma aftermeso-caval shunt,the death rate being 3·5%. A follow-up study showed the recurrence rateswere 10.4% in IVC PTA cases and 1.6% in IVC PTAwith stent cases respectively, and no recurrence was found in other cases.　Conclusions　①PTA is the first choice for localized le- sions without fresh thrombus.②Forthosewith elastic recoil or recurrence, stent is suggested.③Forthosewith both IVC lesions andHVocclusion, the additional operation to reduce portal hypertension is needed after IVC intervention.

参考文献/References:

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备注/Memo

备注/Memo:
①（浙江大学附属第一医院血管外科研究所,杭州,310003）
更新日期/Last Update: 2014-07-31