Holland-Fischer P, Grønbaek H, Astrup L, Keiding S, Nielsen D Tønner, Vilstrup H
Department of Medicine V, Aarhus University Hospital, Denmark.
Scand J Gastroenterol. 2004 Oct;39(10):1025-8. doi: 10.1080/00365520410007935.
The case is presented of a 25-year-old Caucasian patient with Budd-Chiari syndrome due to membranous obstruction of the liver veins and inferior caval vein syndrome as a result of secondary hyperplasia of the caudate lobe of the liver, obstructing the caval vein. Diagnosis was established by intravascular pressure measurements, ultrasound examinations and caval and liver vein angiograms. Treatment consisting of stent placement in the outlet of a hepatic vein and subsequent transjugular intrahepatic porto-systemic shunt (TIPS) insertion via the caval vein was successful. After 34 months of follow-up the stents remain open and the patient is symptom free. This successful combination of stent placement and TIPS has not been described before. The case report is followed by a review of the literature on the use of angioplasty in short hepatic vein stenosis and TIPS in Budd-Chiari syndrome. It is concluded that angioplasty and TIPS are safe and efficient procedures to reduce liver engorgement and complications of portal hypertension in selected patients with Budd-Chiari syndrome.
本文报告了一例25岁的白种人患者，患有布加综合征，病因是肝静脉膜性阻塞以及由于肝尾状叶继发性增生导致下腔静脉综合征，压迫下腔静脉。通过血管内压力测量、超声检查以及下腔静脉和肝静脉血管造影确诊。治疗方法包括在肝静脉出口处放置支架，随后经下腔静脉进行经颈静脉肝内门体分流术（TIPS），治疗成功。经过34个月的随访，支架保持通畅，患者无症状。这种支架置入和TIPS的成功联合应用此前未见报道。病例报告之后是关于血管成形术治疗肝短静脉狭窄以及TIPS治疗布加综合征的文献综述。结论是，血管成形术和TIPS是在选定的布加综合征患者中减轻肝脏充血和门静脉高压并发症的安全有效方法。
