Xu Ke, Feng Bo, Zhong Hongshan, Zhang Xitong, Su Hongying, Li Hong, Zhao Zhongchun, Zhang Hanguo
Department of Radiology, First Affiliated Hospital, China Medical University, Shenyang 110001, China.
Chin Med J (Engl). 2003 Apr;116(4):609-15.
To evaluate the clinical value of various kinds of interventional techniques in the treatment of Budd-Chiari syndrome (BCS).
Multiple techniques such as recanalization of the inferior vena cava (IVC) under the guidance of marker and multi-angled fluoroscopy, recanalization of the hepatic vein with a transjugular approach, PTA, Z-expandable metallic stent (Z-EMS) implantation and modified TIPSS were used to treat 103 patients with BCS.
Of 103 patients with BCS, 59 patients with obstruction of IVC were treated using recanalization of IVC. Seventeen patients with hepatic vein obstruction had their hepatic veins recanalized. The rest of the patients were given other methods of interventional treatment. Of all the subjects, 101 successfully underwent their procedures, with a success rate of 98.06%; and only 2 failed to recanalization of the IVC. Fifty-three patients were treated using PTA for the first time, with a success rate of 100%. In the 48 patients undergoing Z-EMS implantation for the first time, the success rate was 95.8%. Five patients were treated with modified TIPSS. After these interventional treatments, the success rate was 100%. Two patients died 16 h and 72 h respectively after operation because of DIC and severe hemoptysis. Seventy-two patients were followed up for 1 - 94 months (with a mean of 42.3 months). The mean follow-up of a BCS patient treated with PTA was 52.1 months, resulting in a primary patent rate of 59.4% and a restenosis rate of 40.6%. The mean follow-up of BCS treated with stenting was 33.5 months, with a primary patent rate of 87.5% and a restenosis rate of 12.5%. Eight patients died 7 - 64 months after the interventional procedure.
Recanalization of IVC or the hepatic vein transjugularly, PTA, Z-EMS implantation and modified TIPSS can be regarded as safe and effective micro-invasive methods in the treatment of BCS.
评估各种介入技术在布加综合征（BCS）治疗中的临床价值。
采用多种技术，如在标记物及多角度透视引导下进行下腔静脉（IVC）再通、经颈静脉途径肝静脉再通、经皮腔内血管成形术（PTA）、Z形可扩张金属支架（Z-EMS）植入及改良经颈静脉肝内门体分流术（TIPSS）治疗103例BCS患者。
103例BCS患者中，59例IVC阻塞患者采用IVC再通治疗。17例肝静脉阻塞患者行肝静脉再通。其余患者采用其他介入治疗方法。所有患者中，101例手术成功，成功率为98.06%；仅2例IVC再通失败。53例患者首次采用PTA治疗，成功率为100%。48例首次行Z-EMS植入的患者，成功率为95.8%。5例患者采用改良TIPSS治疗。这些介入治疗后，成功率为100%。2例患者分别于术后16小时和72小时因弥散性血管内凝血（DIC）和严重咯血死亡。72例患者随访1 - 94个月（平均42.3个月）。PTA治疗BCS患者的平均随访时间为52.1个月，原发性通畅率为59.4%，再狭窄率为40.6%。支架置入治疗BCS的平均随访时间为33.5个月，原发性通畅率为87.5%，再狭窄率为12.5%。8例患者在介入治疗后7 - 64个月死亡。
经颈静脉IVC或肝静脉再通、PTA、Z-EMS植入及改良TIPSS可被视为治疗BCS安全有效的微创方法。
